Get to know: Dr Anna Seth 

Dr Anna Seth is a Hobart GP with an interest in women’s health, environmental impacts on health, and mental health. After completing her medical degree and internship in the United Kingdom, she moved to Australia in 2003 and worked in various medical specialities in far north Queensland before training in general practice and relocating to southern Tasmania in 2011.  

Anna works at The Bubble Hobart, providing general women’s health care and focussed psychological strategies. She joined Primary Health Tasmania in 2021 as a clinical editor for Tasmanian HealthPathways (tasp.hn/healthpathways) and to support health professional education and training about the national mental health initial assessment and referral (IAR) tool. She is the joint state lead for the Royal Australian College of General Practitioners’ Psychological Medicine Specific Interest Group. 

Fact box: What is the IAR decision support tool? 

The Initial Assessment and Referral (IAR) guidance and its associated online decision support tool aims to assist GPs and other mental health clinicians when they are considering the mental health needs of a patient.   

It was developed by the Australian Government Department of Health and Aged Care and is informed by Australian and international evidence combined with input from health professionals, researchers, and people with lived experience of mental illness.  

The guidance provides a nationally consistent way of describing a person’s mental health across eight holistic domains, and translates that to a recommendation for one of five levels of care. These levels range from self-management to specialist and acute services.    

The aim is to bring consistency and a shared language to decisions about mental health care.  

Primary Health Tasmania is supporting adoption of the IAR decision support tool in Tasmania, including by providing free training to GPs and other primary healthcare professionals in its use. 

Want to know more? Go to our webpage on IAR. 

What challenges are GPs facing when patients present with mental ill-health? 

Mental health conditions are one of the most common issues GPs see and Australia wide, GPs provide the bulk of mental health care.  

The mental health system can be challenging to navigate – especially for those with complex needs, trauma-related disorders, alcohol and substance use, neurodiversity, and the socioeconomic adversity that often comes with these conditions.  

It can often be difficult to know what services are available, how to access them, and exactly what they offer.  

There is a substantial administrative load involved in the coordination of this care, which often falls to GPs.  

How does this impact on patient care? 

For patients and their families, finding mental health care can feel like a long succession of rejections and setbacks. This is not only incredibly frustrating, but can also worsen the mental health conditions for which help is being sought.  

Care is unaffordable to many, and lack of access to services and long wait times where services exist are a huge issue – especially in rural and remote areas. I feel this probably correlates with the fact that Tasmania has the highest per capita rate of mental health prescriptions in Australia as accessible alternatives to pharmacological treatment are lacking. 

How will the IAR decision support tool help? 

Most clinicians are already doing excellent mental health assessments and it’s important that we recognise the clinical expertise of our workforce.  

The IAR guidance is not intended to replace that, however it does represent the minimum of what should be considered when making a mental health referral. Personally, I find it a good reminder to ensure I understand enough about each domain as I get to know a patient. 

Despite good assessments, it is still often a challenge to get referrals across the line to where the person needs to be. By communicating using the common language of the IAR domains and levels of care, we can make it very clear why we are making a particular referral in a consistent way. Use of the IAR decision support tool may also help people to understand why their clinician is recommending a particular type of care, and the focus on collaborative decision-making is very welcome. 

Another good thing about it is that it doesn’t rely on diagnosis to determine the intensity of treatment, which is very sensible. As GPs, we know people don’t fit into neat diagnostic boxes, and prematurely attaching a diagnosis for the purpose of accessing a service is problematic. 

Widespread adoption of the IAR tool has potential to improve the experience of accessing mental health care for patients and clinicians at a system-wide level. However, it must be acknowledged that changing existing systems is a slow and often a bumpy road. There are many varying opinions about the priorities for reform and the IAR project is only one small part of a complex landscape.  

I feel that making the process of getting mental health support more transparent and collaborative is a good thing, and that keeping general practice at the heart of the system is important.  

What has the response been to date? 

The response to date has been mixed, and I understand the hesitancy of GPs to adopt the IAR decision support tool until a critical mass of awareness and integration is reached. GPs very reasonably want to be certain that it is a good use of their time.  

We have so far trained around 25% of Tasmanian GPs and several hundred other providers statewide.  

Feedback is that people find training useful, especially in building awareness of the range of services available and the changes to our mental health referral systems.  

Uptake by GPs has been limited by systemic barriers such as integration with software and the Medicare Benefits Schedule, which are continuing to be addressed at a national level.  

We have restructured our HealthPathways to show mental health services defined by the IAR level of care they provide, and this is something which has been practically useful in helping GPs navigate mental health services – regardless of whether the IAR tool is used. 

Outside of general practice, a growing number of services are now using IAR, including the Medicare Mental Health Centre in Launceston and services delivered by Richmond Futures and Rural Alive and Well.  

An important development has been the rollout of the mental health Central Intake and Referral Service (CIRS) for Tasmania, which gives GPs the option to send an eReferral (with or without an IAR completed) to connect patients to mental health services across the public, private and community sector. CIRS works alongside the Tasmanian Government’s existing Access Mental Health service and the intake teams are co-located. I hope this may ultimately streamline referral processes and reduce frustration for all involved, allowing quicker connections to appropriate services to be made. 

Having the CIRS is an exciting development and I would encourage GPs to make use of this service and provide feedback on its performance, so that we can ensure it meets community need.  

What’s coming next? 

We are continuing to offer regular IAR training to GPs and other mental healthcare providers and have invited various services and topic experts to contribute to training in coming months.  

Nationally, I’m interested in what future system integration developments we may see for this project. There is a great deal of activity in the space of mental health service navigation and I hope ongoing initiatives continue to recognise the role of general practice as a central coordinator and important provider of mental health care. 

Locally, I have always been excited about the possibility of using IAR data to drive service planning by identifying in a very granular way where some of the gaps are. I hope that may be borne out in time. 

I’d encourage my GP colleagues to come along to an IAR training session, ask questions, and provide feedback so that we can continue to contribute our voice to necessary system changes.  

This story features in Issue 19 of our Primary Health Matters magazine. Click here to read the rest of the issue.