I Am a Doctor

Patients can be referred to psychiatrists by GPs for either:

• ongoing care – which might involve transfer of care or a shared care arrangement
• an ‘opinion and report’ (MBS item 291) – where the GP continues to act as the primary health-care provider.

 To refer a patient to a psychiatrist, a letter of referral is required. The letter of referral should contain (where possible):

• the reason for the referral
• the main issues (a summary of the problems, the perceived contributors and any safety concerns)
• medical history and the relevant medical and mental health treatment that has been provided
• whether the referral is for an opinion and report or ongoing management
• whether a psychologist has recommended the GP make the referral (include their specific concerns and contact details).

 If you are concerned about the safety of a patient you have referred to a psychiatrist, you should speak directly to the psychiatrist (over the phone or in person) to tell them about your concerns. This will allow them to take steps to ensure patient safety. Letters are not recommended as a way to convey urgent information.

Mental Health Treatment Plans are not required for psychiatrists, only psychologists. For psychologists, a Mental Health Treatment plan is needed to access Medicare rebates.

If a patient has not significantly improved 6 months after referral to a psychologist, it may be appropriate to refer the patient to a psychiatrist for a second opinion. Inform both parties of the referral.

If you wish to refer an active patient of a psychiatrist to a psychologist, discuss the arrangement with the psychiatrist first.

Simultaneous referrals from a GP to both a psychiatrist (for both psychotherapy and medication) and psychologist (for psychotherapy) can create confusion about treatment. Consider the need for this carefully on a case-by-case basis.

When referring a patient to a psychiatrist, it is important that you discuss the reason for the referral with the patient. This is to ensure that the patient and the psychiatrist have the same expectations from the appointment, including rebates from Medicare.

Key facts about item 291

1. The GP must state that the referral is for an opinion and report (or item 291) on the referral form
2. An opinion and report can be completed in up to three appointments with the psychiatrist
3. The psychiatrist will provide the GP with a detailed written report within 2 weeks of the appointment
4. The psychiatrist can see the patient for treatment after the report has been provided to the GP
5. A patient is only eligible for one Medicare rebate on the opinion and report in a 12-month period, but there is a rebate for a review

There is provision for the psychiatrist to review the opinion and report previously prepared by them, within the 12 month period (MBS item 293).

When referring patients to a psychologist, GPs should provide similar information as per normal GP referral arrangements. The GP should consider including both a statement identifying that a GP Mental Health Treatment Plan has been completed for the patient (including, where appropriate and with the patient’s agreement, attaching a copy of the patient’s GP Mental Health Treatment Plan or psychiatrist assessment and management plan) and clearly identifying the specific number of sessions the patient is being referred for.

The referring practitioner must assess the patient’s need for further services up to a maximum of ten individual per calendar year.

Eligible patients can claim up to ten Medicare rebates for individual services provided by clinical psychologists, appropriately trained GPs or registered psychologists.

Following the initial course of treatment (a maximum of six services but may be less depending on the referral and the patient’s clinical need) GPs can refer patients for further sessions to a maximum of ten services per calendar year

Preparation of a GP Mental Health Treatment Plan (Items 2700, 2701, 2715, and 2717)

Item 2700: for the preparation of a GP Mental Health Treatment Plan by a GP who has

not undertaken mental health skills training, lasting at least 20 minutes to less than

40 minutes.

?  Item 2701: for the preparation of a GP Mental Health Treatment Plan by a GP who has not undertaken mental health skills training, lasting at least 40 minutes.

?  Item 2715: for the preparation of a GP Mental Health Treatment Plan by a GP who has undertaken mental health skills training, lasting at least 20 minutes to less than 40 minutes.

?  Item 2717: for the preparation of a GP Mental Health Treatment Plan by a GP who has undertaken mental health skills training, lasting at least 40 minutes.

Once an initial GP Mental Health Treatment Plan is in place, a new plan should not be prepared unless clinically required and generally not within 12 months of a previous plan.

Ongoing management can be provided through consultation and review services.

Review of a GP Mental Health Treatment Plan (item 2712)

Item 2712 is for an attendance by a GP to review a GP Mental Health Treatment Plan or to review a psychiatrist assessment and management plan.

Recommended frequency is an initial review between four weeks and six months after the completion of the GP Mental Health Treatment Plan and, if required, a further review at least three months after the first review.

The Crisis Assessment and Treatment Team are responsible for assessing all persons who are being considered for hospital admission and determining whether or not a less restrictive setting is more suitable.

CATT services also provide treatment and support for people whose acute mental illness can be managed in the community as an alternative to hospitalisation. 

If you have immediate concerns for a person’s safety, contact 000 or (Frankston/Mornington Peninsula catchment):

For referrals to Peninsula Health Mental Health Service 
Frankston Hospital, Hastings Road, FRANKSTON
Post: PO Box 52, Frankston VIC 3199

1300 792 977 —18 years and over Triage 24 hours
9784 7095 — Aged Person’s Unit

1300 369 012 – Under 18 years Psychiatric Triage (24 hour)

Referral: Via triage service 1300 792 977

• Crisis Assessment and Treatment Service
• Aged Psychiatry Inpatient Unit and Community Team
• Adult Acute Inpatient Unit and Community Unit

Perinatal to Youth Mental Health Service (formerly CAMHS)
4th Floor, 454 Nepean Highway, FRANKSTON
Mel Ref: 102 C2

Phone: 9784 9800
Fax: 9784 9801
24 Hour: 1300 369 012 (Psychiatric Triage)

Self-referral, or by doctor, school or agency.Care, counselling, assessment and treatment of people under 18 experiencing major emotional and psychiatric disorders.
Person must live in Frankston, Langwarrin, Seaford or the Peninsula, but not Pearcedale.

• Further online training can also be accessed via www.psychinterview.com
• CPD training from www.psychscenehub.com
• Major Depressive Disorder with Mixed Features Interactive Learning Tool – CPD

Videos

• Practical Aspects of Switching Antipsychotic Medication
• Emotional Blunting with SSRI’s – Prof Malcolm Hopwood
• Hormones and Mental Illness in Women – PMDD / Depression and the Pill / Perimenopausal Depression
• Prof Jayashri Kulkarni’s Tips On Prescribing Antipsychotics in Pregnancy