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Other considerations

Aboriginal and Torres Strait Islander people

GPs will continue to play a central role in the management of physical and mental health needs of Aboriginal and Torres Strait Islander people with a mental illness.  In recognition of the difficulties in accessing GPs and psychiatrists or other referring health professionals to obtain a referral, ‘provisional referral’ from an Aboriginal Community Controlled Health Service (ACCHS) or Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) could enable service provision to commence while arrangements are being made for the patient to see a GP or a psychiatrist.

Carers and dependants

Systematic approaches to risk assessment follow-up and coordination of care for patients is best practice – taking into account others affected such as carers, children and other dependants.

Specific groups

Particular populations in the community may have special needs, including those people identifying as lesbian, gay, bisexual, transgender, intersex, queer or questioning (LGBTIQ), those from CALD backgrounds, people with a disability, and elderly people.

Rural and remote

GPs in rural and remote areas should also consider the use of telehealth, including telepsychology. For further information on these services, visit the RACGP Telepartnerships in mental health web page.

When stepped care services may not be appropriate

Depending on what is commissioned by the PHN, stepped care services may not be suitable for patients:

  • with acute psychosis or suicidality
  • with intellectual disability
  • with chronic illness or physical disability
  • with situational crises (eg rape, grief, community trauma such as natural disasters)
  • in rural and remote regions (eg where bandwidth and internet access is limited)
  • with low literacy (many e-mental health resources have a minimum literacy requirement).

In these situations, GPs will use established referral pathways and networks to access the care their patients need. This may include referral to their local mental health facility for acute situations, or referral to another appropriate mental health care provider. Identifying a service that best meets their patient’s needs, whether it be a PHN commissioned service or other available service, will assure appropriate care.

Box 2. Determining appropriate treatment for your patient

Consider the following in deciding on the best treatment for your patient:

  • importance of a long-term therapeutic relationship, particularly when the patient is a victim of trauma and struggles to develop and maintain helpful supports
  • GP advocacy for carers and patients, ensuring these people will not  ‘fall through the cracks’ of services
  • physical health of patients with mental illness; for example, people with schizophrenia often die decades earlier than they should due to lifestyle diseases such as diabetes and heart disease8–10
  • public preference for a low-stigma service – patients can consult GPs without admitting to a mental health problem
  • comorbidities
  • importance of life transitions (eg loss and grief, pregnancy, separation)  on mental wellbeing
  • fluidity of mental health services and criteria; the GP may represent the only consistent service in a patient’s treatment
  • social determinants of health, including Centrelink payments, NDIS, housing, employment, education documentation and support crossing between pharmacological and psychological care.


  1. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 2006;3(2):1–14.
  2. Fleischhacker WW, Cetkovich-Bakmas M, De Hert M, et al. Comorbid somatic illnesses in patients with severe mental disorders: Clinical, policy, and research challenges. J Clin Psychiatry 2008;69(4):514–19.
  3. Robson D, Gray R. Serious mental illness and physical health problems: A discussion paper. Int J Nurs Stud 2007;44(3):457–66.


Working with the Stepped Care Model