Rebate cuts jeopardise GP role in child mental health
CHILDREN’S mental health visits to GPs have risen dramatically under the Better Access program and cutting the rebates would leave the profession’s role in child mental health care in doubt, new research suggests.
An analysis of Bettering the Evaluation and Care of Health (BEACH) data by the research project’s own authors also suggests GP involvement in child psychology has become less prescription-focused under Better Access as the family doctor plays a more active ongoing role in the mental health care of young Australians.
The study, published in the latest Australian and New Zealand Journal of Psychiatry, claims to be the first dedicated snapshot on GP treatment of child mental health issues over four decades.
Better Access, which offers rebates for GP mental health plans, was introduced in 2006 but is being scaled back – with some rebates cut by almost half – to save $400 million from next week.
The BEACH paper indicates:
· The proportion of GP mental health visits by patients younger than 15 jumped from 1.4% in 2000–01 to 2.6% in 2008–09
· 16.8% of child mental health visits to GPs claimed Better Access rebates, compared to 7% of GP mental health visits from patients of all ages in 2006–08
· The rate of GPs prescribing medication to children in mental health visits fell from 28.8 per 1000 in 2000–01 to 18.3 in 2008–09
· Child mental health visits to GPs for enuresis, insomnia and “behavioural problems” have fallen dramatically since 1971, while child GP visits for ADHD, anxiety, depression and autism rose.
BEACH director and report co-author Associate Professor Helena Britt said the study confirmed Better Access had led to a massive increase in children being treated by their GPs for mental health issues and predicted the rebate cuts would have an impact.
“With the decreased payments to GPs and the decreased number of [psychologist] visits being covered by the program, I’m sure there will be an effect on the extent to which GPs are involved in children’s psychological problems, as with adults,” she told MO.
Dr Emil Djakic, chair of AGPN – a member of United General Practice Australia (UGPA), which is fighting the rebate cuts – said changes to funding child mental health treatment “need to be done with some caution”.
He said the cuts would fund programs targeting children with more complex psychological problems but lamented “the fact that that’s been done, rather than by building on funding for primary healthcare, by a relative change of funding for the general practice side of the equation”.
Australian and New Zealand Journal of Psychiatry 2011; online 22 October, DOI:10.3109/00048674.2011.610743