Harry Minas1,2 and Steven Klimidis1,2
Associate Investigator: Renata Kokanovic1
1 Centre for International Mental Health, School of Population Health, University of Melbourne, and
2 Victorian Transcultural Psychiatry Unit, St. Vincent’s Health Melbourne
beyondblue Victorian Centre of Excellence
Project completion year
The Better Outcomes in Mental Health Care (BOiMHC) initiative recognises the important role of general practitioners (GPs) in the provision of mental health care in the community and the fact that GPs require additional training and support to effectively fulfil this role.
The objectives of this study were:
(1) to investigate the impact of the BOiMHC program on attitudes of GPs to provision of mental health care, needs for training, level of confidence in provision of mental health care, and level of engagement with specialist mental health practitioners and services
(2) to explore the impact of the program on capacity to respond effectively to the mental health needs of ethnic minority patients.
With the assistance of the Health Insurance Commission, a survey instrument was posted to 2,500 GPs in metropolitan Melbourne. Five hundred and ninety-eight (598) completed responses (23.9 per cent) were returned. Demographic and practice features of the sample (comprising 15.1 per cent of Melbourne GPs) were very similar to those of the general population of Australian GPs, except that the sample had a higher proportion of females (48.8 per cent and 33.2 per cent respectively) and a higher proportion were registered with BOiMHC (28.4 per cent and 17 per cent).
There is a high level of interest among GPs in mental health work - significantly higher among GPs who are registered with the program. Both GPs registered with the program and those not registered, express a high level of need for further mental health training, and for greater access to specialist advice and supervision.
GPs express less confidence in dealing with low-prevalence disorders than with high-prevalence disorders.
A major problem is the low level of availability of mental health specialists and specialist services to GPs. Nearly two thirds of GPs (65.7 per cent) express a need for better co-ordination between general practice and specialist services.
It is surprising to find there are no systematic differences between registered and non-registered GPs in the frequency with which they manage patients on their own, refer them to specialists for management or undertake joint management. It is not clear whether the high proportion of patients managed solely by GPs is the result of GPs’ (or patients’) preference for sole management or is due to insufficient availability of referral and collaborative care options.
When dealing with ethnic-minority patients, BOiMHC-registered GPs report significantly less problems than non-registered GPs in access to bilingual allied mental health practitioners, interpreters and translated materials.
There is no difference between the groups in access to guidelines for working with interpreters and transcultural mental health practice guidelines.
It is important to note that, while BOiMHC-registered GPs have less problems than their non-registered colleagues in a number of areas, the proportion who experience such problems is high, ranging from 38 to 70 percent of the total sample.
It is of particular concern that two thirds of GPs report difficulties in securing the co-operation of their ethnic-minority patients in the clinical process, and in this regard BOiMHC-registered GPs are no more successful than non-registered GPs.
Implications for Policy and Practice.
BOiMHC has had a positive, though modest, impact on mental health practice in primary care. However, the impact of the program on capacity to provide high-quality mental health care in general practice to people from ethnic-minority groups is marginal at best.
A substantial proportion of GPs, whether BOiMHC-registered or not, continues to experience significant difficulties in getting access to appropriate resources and expertise, and in engaging ethnic minority patients in clinical care.
The BOiMHC initiative needs to appreciate better, and respond to, the cultural and linguistic diversity that is an essential feature of the Australian population. This appreciation needs to be reflected in BOiMHC training programs and in further evaluations of the program.
While bilingual specialist mental health clinicians are scarce, there are a substantial number of bilingual GPs who could be providing high-quality mental health care with better-targeted training and support.
While BOiMHC is potentially a suitable vehicle for this purpose, its potential in this regard is not currently being realised.
In collaboration with GP colleagues (Minas, Klimidis et al. 2005) the team intend to continue to investigate ways in which GPs can be supported to provide the best possible mental health care to people from ethnic minority communities in Victoria.
Klimidis, S., H. Minas, et al. (2006). "Ethnic minority community patients and the Better Outcomes in Mental Health Care initiative." Australasian Psychiatry 14(2): 212-5.
Minas, H., S. Klimidis, et al. (2005). "Mental health research in general practice." Australasian Psychiatry 13(2): 181-4.
Minas, I., S. Klimidis, et al. (2005). "Impact of Australia’s 'Better Outcomes in Mental Health Care' initiative in Melbourne." Primary Care Mental Health 3: 111-121.