Cameron is a GP in Melbourne, with extensive experience in treating people with mental health challenges.
Treating mental health comprises about one third of my work. I have worked with patients for over 15 years in the community and have first‑hand insight into the practical problems that patients face seeking appropriate treatment.
Cameron said that in his experience, accessing support for people with severe mental illness can be challenging, especially when he compares it with referring people to other specialist services.
It is important to appreciate the contrast between the way mental health (psychiatric) services are now provided, compared to the rest of healthcare. In every other part of medicine, the approach to services is straightforward … The problem is diagnosed, treated at that contact and, if necessary, referrals are made to appropriate specialist medical or allied health providers.
Cameron says he has required expert assistance to support his patients, which he has not been able to access in the public mental health system.
There are times when I specifically want an expert opinion from a specialist psychiatrist that would make a significant difference to treating the patient. A common example would be establishing a diagnosis of bipolar affective [disorder], which is often subtle. I cannot get that in the public health system in Victoria.
He has also often not been able to refer people to the public mental health system for treatment, care and support.
Referrals are often rejected out of hand, and never redirected to an alternate service if the first service does not want to take them on.
Cameron suggests there should be a simple central intake process, because it is currently too complicated.
I may try to refer to the local area mental health service, but there is no central referral system. Each part of the service has its own separate referral requirements, which change frequently.
To illustrate, in my local area, the local crisis assessment service, aged persons psychiatry service, child and adolescent mental health service and primary mental health service are all run by the same area mental health service, but have their own unique referral processes. This often involves complicated proformas and specific phone calls, just to make a referral.
Cameron also suggests that the different treatment, care and support options should be clearer, with pathways such as outpatient psychiatry easily available for referral and assessment, as well as the various other services that are required.
For mental health (psychiatric) care, beyond the general practitioner, the services are a mess. If I would like a patient to see a public psychiatrist, or wholly publicly funded psychologist, there is no straightforward process for this. If I want to organise a case manager, or some assistance with peer support, or to find some social activities for a patient to engage with, or special assistance finding suitable accommodation, there are no defined pathways for this.
Cameron says there should be clear and uniform naming conventions of services and roles across the state, with a reduction in the types of services, to make the system easier to understand and more accessible.
Cameron also advocates for better access to suitable accommodation, among other supports for people with severe mental illness in the future mental health system.
There would be access to stable, appropriate accommodation and there would be access to financial support. There would also be support services for the family and friends of the patients.
Source: Dr Cameron Martin, Submission to the RCVMHS: SUB.0002.0028.0508, 2019.