Using the Better Access initiative, MHTPs, CCMPs and the IAR-DST in stepped care

The Better Access initiative is generally appropriate for consumers with mild–moderate symptoms and is only one approach to deliver mental health care. For example, care coordination or disability support services might be appropriate for people with severe mental illness, and digital programs and self-help strategies might suit people with milder symptoms. 

Eligibility for the Better Access initiative

For a consumer to be eligible for this scheme, they must have an MHTP with an MBS-stated eligibility requirement of a formulation/diagnosis, completed in consultation with a GP. 

Interventions available under the Better Access initiative

Interventions the consumer may receive as part of their MHTP referral under the Better Access initiative include:

• face-to-face psychological therapy
• FPS delivered by a GP
• online therapy or another low-intensity service (for consumers with mild illness), accessed via a local PHN.

An MHTP:

• provides a clear, simple and structured way to perform an early intervention as well as accurately assess and manage the consumer’s illness and progress
• identifies holistic needs and provides appropriate referrals to allied mental health service providers
• enables the GP to talk to the consumer about the issues concerning them and understand the consumer’s goals of treatment
• ensures that the consumer and, where possible, their carer(s) are actively involved in the consumer’s treatment
• helps coordinate the consumer’s care and can be provided to the consumer as a resource
• provides continuity and a ‘cycle of care’ for the consumer
• facilitates periodic reviews of the care plan and the consumer’s progress with the consumer and carer(s).

How MHTPs are best used

Initial assessment and planning: These items fund the time needed for a comprehensive assessment and development of a tailored mental health care plan and are used for consumers with clinically diagnosable disorders who need a structured approach.

Provision of Better Access services: After the plan is created under one of these item numbers, the Better Access scheme enables consumers to access:

• up to 10 Medicare-rebated allied mental health sessions per year (eg with their GP, psychologists, social workers, OTs), and/or
• up to 10 group therapy sessions per year (eg with psychologists, social workers, OTs).

Referral documentation: The MHTP should clearly specify treatment goals and referrals, which also helps allied health providers claim rebates.

In the context of the Better Access initiative, a GP may use a CCMP for consumers with chronic or complex mental disorders to support a coordinated, multidisciplinary approach to care. While an MHTP enables access to psychological therapy, the CCMP complements this by organising broader supports, such as allied health and other providers, helping ensure ongoing, holistic and consumer-centred management. 

How CCMPs are best used

Consumer’s symptoms: Create a CCMP when symptoms are persistent (≥ six months), cause functional impairment, and require ongoing GP involvement rather than episodic care. Mental illness can qualify as a chronic condition, and a consumer may have both a physical and mental condition.

Management of multiple services: These plans support team-based management across psychology, psychiatry, allied health and physical healthcare, which is particularly important when the consumer presents with comorbidities or psychosocial complexity.

Allied health access: The consumer can receive Medicare rebates for allied health services (commonly up to five sessions per year), such as those provided by:

• psychologists
• dietitians
• exercise physiologists
• OTs
• Aboriginal Mental Health Care trained clinicians

Follow-up: These plans enable planned follow-up, reviews of goals and adjustment of care over time, thereby reducing crisis-driven presentations and fragmented care.

See MBS Online for all Medicare item number information, including telehealth equivalents. 

The Initial Assessment and Referral Decision Support Tool (IAR-DST)

The IAR-DST is a tool developed for Australian primary mental health care that is designed to:

• help clinicians assess psychological distress, functioning, risk and complexity
• support consistent referral decisions
• help GPs identify the level of care a consumer requires and deliver a recommended level of care that is aligned to stepped care principles.

The tool supports, but does not replace, clinical judgement. Use of this, or any other decision-support tool never replaces a GP’s responsibility for diagnosis, treatment planning and review. 

How the IAR-DST supports stepped care

By promoting a needs-based approach rather than diagnosis alone, the IAR-DST encourages you to consider the consumer’s:

• symptom severity
• functional impairment
• risk factors
• psychosocial complexity.

As such, it can also inform your decisions based on an MHTP and provide documentation supporting your clinical reasoning about the level of care required.

It also supports:

• timely access to appropriate care
• more consistent referral pathways