Mental Health Treatment Plans - NorthWestern Mental Health
Mental HealthTreatment PlansA guide for health professionalsworking in general or private practice
How to Prepare a Mental HealthTreatment PlanPatients with a mental health condition,including those with a chronic ornon-chronic diagnosis, benefit fromstructured management of their treatmentneeds and referral to appropriate services.A Mental Health Treatment Plan (also known asa Mental Health Care Plan) must be completedwhen referring a patient to a psychiatrist,psychologist, eligible social workers oroccupational therapists (providing focusedpsychological strategies) through the MedicareBenefits Schedule (MBS).Referrals made under the Better Access initiativeor the Access to Allied Psychological Services(ATAPS) program both requires a Mental HealthTreatment Plan. (For more information aboutthese programs go to page 4).This guide provides useful information on howto complete the Mental Health Treatment Plan.Assess, Plan, ReferPreparing a Mental Health TreatmentPlan for your patients will involve bothassessing the patient and preparing theMental Health Treatment Plan document.AssessAn assessment of a patient must include: recording the patient’s consent for the MentalHealth Treatment Plan taking relevant history (biological, psychological,social) including the presenting complaint conducting a mental state examination (MSE) –see page 3 for more information assessing associated risks and any co-morbidity making a diagnosis administering an outcome measurement tool see page 3 for more informationPlanPreparing a Mental Health Treatment Plan mustinclude: discussing the assessment with the patient,including the diagnosis and recording of thisdiagnosis in the Plan identifying and discussing referral and treatmentoptions with the patient, including appropriatesupport services developing goals with the patient – what shouldbe achieved by the treatment - and any actions thepatient will take provision of psycho-education – see page 4 formore information a plan for crisis intervention and/or for relapseprevention (if required) making arrangements for required referrals,treatment, appropriate support services, review andfollow-up documenting the assessment and plan in thepatient’s Mental Health Treatment Plan – see page 5for more informationReferralDepending on your patients’ needs you can makea referral direct to a psychologist, psychiatrist,counselling service or occupational therapist through the Better Access Program, or through theAccess to Allied Psychological Services (ATAPS)CAREinMINDTM program.Medicare Benefits Schedule (MBS)Medicare items for Mental Health Treatment Plans,Reviews and Consultations are available for patientsliving in the community (or privately fundedresidents of aged care facilities).MBS items 2700, 2701, 2715 or 2717 can be claimed.MBS item 2712 is used when reviewing the GPMental Health Treatment Plan.Please note: The assessment can be part of thesame consultation in which the Mental HealthTreatment Plan is developed, or they can beundertaken in different visits.For more information about the MBS items go toAppendix 1.1
Mental Health Treatment PlanDoes your patient already have aMental Health Treatment Plan (MHTP) ?If no, complete a newMental Health Treatment PlanUse MBS items: 2700, 2701, 2715, 2717Assess the Patient Record consentTake relevant historyConduct mental state examinationAssess the associated risk and any comorbidityMake diagnosis or formualtionAdminister outcome measurement toolPlan Discuss assessment with the patient Identify and discuss referral and treatmentoptions with the patient Agree on goals with the patient Document the above steps in the MHTP GP and patient sign and date the planReferralRefer patient to an appropriate service/clinician asagreed with the patient. Include: Referral Data Form (if referring to ATAPS) MHTP number of sessions required.To find out if your patient has had a MHTPin the past 12 months call MedicareAustralia on 132 150Exceptional CircumstancesA new MHTP may be required within a12 month period if your patient has had a: Significant change to their mentalhealth Change of clinical service and you areunable to obtain a copy of the MHTP. (Use MBS items: 2700, 2701, 2715, 2717 ‘exceptional circumstances’) More information:www.mbsonline.gov.auServicesAccess to Allied Psychological Services(ATAPS) CAREinMIND Referrals to centralised intake system atNorth Western Melbourne PHN Eligible patients: health care card, lowincome. Free serviceBetter Access Referral direct to a psychologist,psychiatrist, counselling service oroccupational therapist. Medicare rebates availableFurther information: North Western Melbourne PHN:www.nwmphn.org.au or 9347 1188Review(Use MBS item 2712)After the initial course of treatment (usually 6sessions) a review of the patient’s progress againstthe goals outlined in the MHTP is required. Discuss progress with the patient Assess need for further treatment Re-administer the outcome measurement tool Offer a copy of the reviewed plan to the patient- Add to patient’s records- Send a copy of the reviewed plan to service2 Medicare (claims and item enquiries):www.mbsonline.gov.au
Mental Health Treatment Planstep by stepReviewMental State Examination (MSE)After the initial course of treatment (usually 6sessions) a formal review (MBS item 2712) of thepatient’s progress against their Mental HealthTreatment Plan and their need for further treatmentis required. The mental health service provider willusually make a request for a review at this time.It is recommended that all components of the MSEshould be considered at each assessment: Appearance Behaviour Speech Content of speech Mood and affect Thought Perception Cognition InsightPlease note: You do not have to complete anotherMental Health Treatment Plan.The review must be completed in person with thepatient and include: recording the patient’s agreement for the service review of the patient’s progress against the goalsoutlined in the Mental Health Treatment Plan modifying the Plan (if required) checking, reinforcing and expanding education a plan for crisis intervention and/or for relapseprevention, if appropriate and if not previouslyprovided re-administration of the outcome measurementtool used in the assessment stageA copy of the reviewed Plan must be offered to thepatient (or carer, if appropriate) and a copy of thereviewed Plan added to the patient’s records.A copy of the review must be sent to theCAREinMIND team at NWMPHN if the patientis accessing ATAPS. Sessions 7-12 will continueafter the review has been received andprocessed by NWMPHN.Department of Health and Human Services, 2016, GP MentalHealth Treatment Medicare Items, tent/pacd-gp-mental-health-care-pdf-qa3For more detail about conducting the MSE go toappendix 2.Outcome Measurement ToolsOutcome Measurement Tools include: Depression, Anxiety and Stress Scale (DASS21) Kessler Psychological Distress Scale (K10) Short Form Health Survey (SF12) Health of the Nation Outcome Scales (HoNOS)It is at the discretion of the practitioner as to whichoutcome tool is used.If you are not familiar with the OutcomeMeasurement Tools or would like more information,training and education is available throughthe General Practice Mental Health StandardsCollaboration, www.racgp.org.au/education/gpmhsc/.
Psycho-educationBetter Access and ATAPSPsycho-education occurs in a range ofcontexts and may be conducted by a variety ofprofessionals, each with a different emphasis. Ingeneral, however, four broad goals direct mostpsycho-education efforts:To determine whether Better Access or ATAPS is themost appropriate referral option for your patient,refer to appendix 4.1. Information transfer (as when clients/patientsand their families and carers learn about symptoms,causes, and treatment concepts).Access to ATAPS is a free, short term serviceassisting people to a range of mental health issuesincluding:2. Emotional discharge (a goal served as thepatient/client or family ventilates frustrations duringthe sessions, or exchanges with similar others theirexperiences of the problem).3. Support of a medication or other treatment,as cooperation grows between professional andclient/patient and adherence and complianceissues diminish.4. Assistance toward self-help (that is, trainingin aspects such as prompt recognition of crisissituations and knowledge of steps to be taken).Australian Institute of Professional Counsellors, 2014,Psychoeducation: Definition, Goals and Methods, n-goals-and-methods/Mental Health Treatment Plan TemplatesTo ensure all relevant information is provided andto support the most appropriate referral for yourpatient it is recommended to use a Mental HealthTreatment Plan template. Templates are availablefrom: anxiety (e.g. sleep difficulties, panic attacks andgeneral stress) depression (e.g. low mood, poor motivation,low self-esteem) perinatal depression drug and/or alcohol misuse relationship and family difficulties(e.g. conflict, separation, parenting difficulties) life transition, and bereavement.Specialist services are also available to supportchildren and young people, and people at risk ofsuicide or self-harm.Referring to ATAPS CAREinMINDReferring GPs must provide both a completedreferral data form and mental health treatment planwhen referring to ATAPS CAREinMIND (NB: Anexception is the ATAPS Suicide Prevention Service,which does not require a mental health treatmentplan). North Western Melbourne PHN: www.nwmphn.org.au/careinmindReferral forms and the mental health treatment plantemplate are available on our website:www.nwmphn.org.au The Royal Australian College of GeneralPractitioners (RACGP): althtreatment-plan-templates/For further information about referring to ATAPSCAREinMINDPlease note: It is not mandatory to use anyparticular form when preparing and claiming for aMental Health Treatment Plan, but it is mandatoryto document all of the Medicare requirements (asoutlined in Appendix 3).4ATAPS CAREinMINDContact: ATAPS CAREinMIND CoordinatorPhone: (03) 9088 4277Secure Fax: (03) 9348 0750Email: careinmind@mpcn.org.au
Mental Health Treatment PlanExampleBelow is a good example of a patients Mental Health Treatment Plan. It includesall of the Medicare requirements to ensure the patient receives the best possibletreatment for their mental health condition.5
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Case Study ExampleProvided below is a case study of a patientpresenting with a mental health disorder.The case study demonstrates a goodexample of the presenting issue, patienthistory, risks and co-morbidities and thepatient plan (requirements of the MentalHealth Treatment Plan).Case study - JackPresenting problem:Risk:Jack is a 55 year old male presenting withdepression and anxiety. Jack lost his job two yearsago following his position being made redundantand reports worsening of symptoms since this time.Jack reports ongoing suicidal thoughts with no planor intent. He said he couldn’t do that to his children.He has not made any attempts in the past.Jack lives on his own. He has two adult children.Jack reports frequent alcohol consumption, 2-3drinks per day. He said he enjoys drinking in theevening as he finds it relaxing.History:Jack reports experiencing depression andanxiety for most of his adult life. He has beenon antidepressants in the past (many years ago)however ceased them due to unwanted side effectsof nausea. Jack accessed counselling around thetime he separated from his wife (5 years ago). Hereports that he found it helpful.Jack reports no family history of mental illness,however said that his brother has had issues withillicit substance use in the past.7He identifies one good friend who he has knownsince he was a teenager that is a good support forhim.Jack wants help however reluctant to commenceantidepressants. He is keen to commencecounselling.Plan: Commence antidepressant Refer to ATAPS Review in a weeks’ time Provide patient with phone numbers to PsychTriage and Lifeline
8***†at least 20 mins-GP consultation in relation to a mental disorder **Involves: taking relevant history, identifying presenting problem(s), providing treatmentand advice, providing referral for other services or treatments and documenting theoutcomes of the consultation.Review of GP Mental Health Treatment Plan or Psychiatrist Assessment andManagement Plan *Involves: recording patient agreement, reviewing progress against goals, modifyingplan as required, reinforcing education, developing a relapse prevention strategy andre-administration of the measurement tool (unless clinically inappropriate).Preparation of a GP Mental Health Treatment Plan *Involves: an assessment (agreement, history, examination, risks, diagnosis,measurement tool) and preparation of a plan (discuss the assessment and referraloptions, agree goals, provide psycho-education, plan prevention, make supportarrangements). Document the assessment, plan and review date.Service description†No restriction.Review 1-6 months frompreparing the GPMHTP.Further review 3 months after†first, if required.Not within 12 months of a claimfor 2700. 2701, 2715 or 2717 (anew plan should not be preparedunless clinically required).†Not within 3 months of a claimfor item 2712.FrequencyTreatment options include psychiatrist, psychologist, trained GP or allied mental health professional; pharmacological and/or community services.Referral: patients with GPMHTP prepared within last 12 months eligible for up to ten Medicare services per calendar year, from clinical psychologists,trained social workers or occupational therapists providing focused psychological strategies. Maximum of six visits in any one referral. Followingfeedback from the service, make a further referral if indicated (up to the total of 10 per calendar year). Additionally, up to ten group sessions can beclaimed.Before making a claim read the item descriptors & explanatory notes at: www.mbsonline.gov.auFor fact sheets, Q&A, and templates see: www.health.gov.au/mentalhealth-betteraccessSee also ATAPS CAREinMINDTM information: www.nwmphn.org.au/careinmindP (03) 9347 1188 F (03) 9347 7433 Level 1, 369 Royal Parade PO Box 139 Parkville VIC 3052 www.nwmphn.org.au --at least 40 minsat least 20 minsat least 40 minsat least 20 minsTimerequirementTo use these items recognised GP mental health skills training is required. It is strongly recommended that GPs preparing mental health treatment plans have appropriate training. ContactGPMHSC re training options: Tel 03 8699 0554 or email gpmhsc@racgp.org.auService not associated with a service to which item 2713 or 735 to 758 applies.Service not associated with a service to which item 2700, 2701, 2715, 2717 or 2712 applies.Except where there has been a significant change in the patient's clinical or care circumstances that requires the preparation of a new GPMHTP / Review. 71.702713 ** 71.702712yes 134.10noyes 105.552701 *noGPtraining 91.05 71.702700 *2715* 2717* FeeMBSitemPatients with a mental health condition, including those with chronic or non-chronic diagnosis, benefit from structured managementof their treatment needs and referral to appropriate services. Medicare items for GP Mental Health Treatment Plans (GPMHTP),Reviews and consultations are available for patients living in the community (or privately funded residents of aged care facilities).[Dementia, delirium, tobacco use and mental retardation are not included in criteria for these services.]Better Access to Mental Health initiativeGP Mental Health TreatmentAppendix 1 – MBS Item Numbers
Appendix 2 – Mental StateExamination (MSE)All components of the MSE (listed below)should be considered when assessing thepatient.Appearance All aspects of the person’s appearance includingfacial appearance, clothing, grooming and self-careare observed.Rapport The attitude of the person to the examination,and any counter transference experienced by theexaminer (e.g. a sense of threat or discomfort) canalso be noted at this point.Behaviour The person’s posture and level of activity areimportant and may give clues about their mood, forinstance psychomotor retardation in depression. Some disorders and side effects are alsoassociated with particular movement disorders,e.g. tremor and bradykinesia (abnormally slowmovement) with Parkinson’s disease or theextrapyramidal side-effects of antipsychoticmedication. Specific movement patterns such as echopraxia(involuntary imitation of the movements of others)may indicate catatonia. The person’s composure and distractibilityduring the interview should be noted.Speech The spontaneity of speech is important. Somepeople with depression or the negative symptomsof schizophrenia display little or no spontaneity,and a lack may also be observable in catatonia. The volume of voice and rate of speech may beraised in anxiety, mania or anger, and lowered indepression. Similarly, these conditions may affectthe quantity of speech. The flow and interruptibility of speech may alsobe affected, for instance in mania the speech maybe pressured and it may be impossible to redirectthe person from their topic of choice.9 The form of speech may indicate a disorder ofthought form. In persons who have a neurologicalor specific speech disorder (e.g. stuttering) this maynot be the case.Content of speech The overarching and characteristic themes ofthe person’s conversation, including the positivityor negativity of these themes, the normality ofcontent and any evident preoccupations should benoted here.Mood and affect Mood is a person’s prevailing emotionalstate, and affect is the observed responsivenessof their emotional state. A person may have apredominantly elevated mood and a highlyreactive and labile affect, veering rapidly fromenthusiasm to anxiety to irritability to laughter. If the person’s mood appears depressed,questions probing suicidal ideation should be asked.Thought Thought is not directly observable, it is inferredfrom observing speech and behaviour. Thequantity of thought should be noted: poverty ofthought may occur in depression, dementia orschizophrenia. The rate of thought is affected in asimilar manner to the rate of speech for the mostpart: many people with mania have pressure ofthought and some people with depression havebradyphrenia (slowed thought stream). The form of thought may indicate specificproblems. Several types of thought disorder,such as tangentiality, derailment and neologismsmay indicate psychosis. Clanging or punningassociations are often indicative of mania andthought blocking and echolalia (automaticrepetition of another’s words) may indicate thepresence of catatonia. Thought disorder may be sosevere that no sense can be made of the person’sconversation (‘word salad’). The content of thought may include delusionalthinking: a fixed false belief that is not normal for theperson’s background. The nature of the delusionand the degree of conviction with which it is heldmay be very important in determining risk.
Appendix 2 – Mental StateExamination (MSE) continuedSuicidal and homicidal ideas, and the presence andnature of any obsessions, are also considered inthought content.PerceptionCognition Hallucinations (a perception in the absence ofsensory stimulus) may affect any sense (auditory,tactile, olfactory, visual and gustatory). This involves assessing the person’s orientationin time, place and person. The most common type of hallucination inmental illness is auditory. It is particularly important to enquire aboutcommand hallucinations, where individuals hearand sometimes obey voices that command themto perform certain acts - especially if that mayinfluence them to engage in behaviour that isdangerous to themselves or others.10 If this appears in any way impaired, then asubtest called the Mini Mental State Examination(MMSE) may be performed. MMSE may revealunderlying cognitive impairment for furtherinvestigation and diagnostic clarification.Insight Illusions are similar to hallucinations, but involvemisperception of a real stimulus. A complex and highly individualised concept.It includes an account of the person’s perceptionof the nature of the problem, the cause of theproblem, why it continues to be a problem andwhat might be done to help resolve the problem. Depersonalisation and derealisation are oddexperiences where the person feels as thougheither they themselves or the world around themare unreal. Both are often associated with anxiety.Mental Health Professional Online Development (MHPOD),2004, Mental State Examination (MSE), www.mhpod.gov.au/assets/sample topics/combined/Mental health histories andMSE/3MHHM objective2/index.html
Appendix 3 - Mental HealthTreatment Plan – MedicareRequirements Patient’s name Date of birth Address Phone Carer details and/or emergency contact(s) GP name/practice Other care plan e.g. GPMP/TCA (yes/no) AHP or nurse currently involved in patient care Medical records no. Presenting issue(s) - what are the patient’scurrent mental health issues Patient history - record relevant biological,psychological and social history including anyfamily history of mental disorders and any relevantsubstance abuse or physical health problems Medications (attach information if required) Allergies Any other relevant information Results of mental state examination - record afterpatient has been examined Risks and co-morbidities - note any associatedrisks and co-morbidities including risks of self-harmand/or harm to others Outcome tool used and results DiagnosisDepartment of Health and Human Services, 2016, GP mentalhealth treatment plan sample template - Better Access .nsf/content/mentalba-gpsamp11
Appendix 4 – CAREinMINDATAPS and Better AccessTMCAREinMIND ATAPSBetter AccessSessionsper calendar yearMental Health TreatmentPlanEligibilityUp to 12 sessionsUp to 10 sessionsRequiredRequiredClinically-diagnosed mentaldisorder and a holder of a HealthCare Card (or those in genuinefinancial hardship – i.e. not ableto afford gap payments under theBetter Access (Medicare) scheme)Clinically-diagnosed mentaldisorderCost to patientFree (no cost)Medicare rebates availableWho is not eligible?Acute/crisis referrals People who require long-termtreatment (with chronic, severeor long-term (persistent) mentalillness) Individuals who have alreadyutilised Better Access (Medicare)funding in the same calendar yearReview after 6 sessionsRequiredRequiredReferral processReferrals are made to a centralisedintake system at North WesternMelbourne PHN - CAREinMINDPatients are allocated to the mostappropriate ATAPS provider by thecentralised intake teamReferrals are made directlyfrom the GP to the appropriateclinicianMedicare rebates availableProvidersPlease note: If the patient or GPknows an ATAPS provider, theymay select their preferred provider.This must be included on thereferral form12
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GP Mental Health Treatment Better Access to Mental Health initiative Patients with a mental health condition, including those with chronic or non-chronic diagnosis, benefit from structured management of their treatment needs and referral to appropriate services. Medicare items for GP Mental Health Treatme nt Plans (GPMHTP), Reviews and c
Mental Health, Mental Health Europe NGO and the UK Royal College of Psychiatrists7. "No health without mental health" has also been adopted by the Irish organisation Mental Health Ireland, Supporting Positive Mental Health. Burden of Mental Disorders Mental disorders have been found to be common, with over a third of people worldwide
A mental health policy (1996) and plan (2007-2011) existed. Emergency and disaster plans for mental health did not exist. Legislation A new Mental Health Act 846 2012 was passed in 2012 and was awaiting Government to establish the Mental Health Board. Financing of mental health services Mental health had a ring-fenced budget of 1.4% of
3.2 european Policy 12 3.4 Happiness and wellbeing debates 14 4.0 Concepts and definitions: what is mental health? 15 4.1 Dual continuum model of mental health 16 4.2 Measuring mental health 17 5.0 Benefits of mental health promotion 19 5.1 Benefits of preventing mental illness 19 5.2 Benefits of promoting positive mental health 22
3.1 Prevalence of mental ill health 9 3.2 Mental health service need 9 3.3 Mental health service provision gap 10 3.4 Housing system and homelessness 10 3.5 Entries into homelessness 11 3.6 Mental health and housing system capacity 12. 4 Links between housing and mental health 13 5 Housing for people with lived experience of mental ill health 16
mental health is about much more than mental illness, and that there are significant benefits to be gained by approaching mental health from a public health perspective. Positive mental health, mental wellness and mental health promotion have emerged as the missing pieces in a system that has traditionally been
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Communityed-bas mental health services initiated within 30 calendar days of referral coordinating mental health services with a student's primary mental health care provider and other mental health providers involved in student care. Assisting a mental health services provider or a behavioral health provider as described in s. 1011.62, F.S.,
Anatomy Fig 1. Upper limb venous anatomy [1] Vessel Selection Right arm preferable to left (as the catheter is more likely to advance into the correct vessel), vessel selection in order: 1. Basilic 2. Brachial 3. Cephalic Pre-procedure Patient information and consent Purpose of procedure, risks, benefits, alternatives. Line care: Consider using local patient information leaflet as available .
