What a Mental Health Treatment Plan actually is

Of everything general practice does, this is probably the least understood. People arrive believing they need to have reached some threshold, or to be able to explain themselves properly, before they are entitled to ask. Neither is true.

What the plan is for

Two things. First, it is a structured conversation: what has been happening, for how long, what it has affected, and what you want to be different. That conversation is useful in itself, and for some people it is the first time they have said any of it out loud.

Second, it is the mechanism that gives you access to Medicare-subsidised psychology sessions. Without a plan you can still see a psychologist privately, but you pay the full fee. With one, Medicare rebates a substantial part of it for a set number of sessions each calendar year.

How to ask for one

Ring reception and say you would like a long appointment about your mental health. That is all they need to hear, and it is enough for them to book double the usual time. You do not have to explain anything further to anyone at the front desk.

The extra time matters. Raising something difficult with one eye on the clock is unpleasant and unproductive, and a long appointment costs you nothing more than a standard one.

What happens in the appointment

Your GP will ask what brought you in. Start anywhere — "I don't really know where to start" is a perfectly good opening, and a common one.

Expect questions about sleep, appetite, energy, concentration, how you are coping at work or at home, alcohol, and what support you have around you. Expect to be asked whether you have had thoughts of harming yourself. That question is asked of everybody in this situation; answering honestly is what gets you the right help, and it does not take the decisions out of your hands.

Sometimes a blood test is part of it. Thyroid problems, low iron, low B12 and sleep apnoea can all produce or worsen symptoms that look exactly like depression, and they are worth ruling out rather than assuming.

What the plan contains

A written summary of what is going on, what the treatment is aiming at, and who is involved. You get a copy. It goes to the psychologist you are referred to, which means your first session with them starts from something rather than from scratch.

The number of subsidised sessions is set by Medicare and has changed several times in recent years, so ask at your appointment rather than going by what a friend was told. There is a review with your GP partway through, which is not a formality — it is where the plan gets adjusted if what you are doing is not working.

About medication

Medication is one option among several, not the automatic outcome of the appointment. For many people therapy alone is the right starting point, and for others a combination works better than either alone.

If medication is discussed, you should leave understanding what it does, what it does not do, how long it takes to work — usually a few weeks, which surprises people — and what the side effects are likely to be in the first fortnight. The decision is yours.

What if the first thing does not work

That is common, and it is why review appointments exist. The first psychologist is not always the right fit, and the first medication is not always the right one. Changing either is ordinary, not a setback, and it is a considerably better outcome than quietly giving up.