Mental health issues continue to dominate the reasons why people see a GP, and guidelines increasingly recommend behavioural therapies like CBT and DBT as first-line treatments for many psychological problems — including trauma disorders and mood disorders – as well as for chronic pain and insomnia.

Yet while four in 10 GPs say they personally administer behavioural therapy at least sometimes, six in 10 rarely or never do—and 86% mostly or always refer patients to a psychologist, a Healthed survey of over 1500 GPs found.

But it’s not for lack of interest.

When we asked GPs about the barriers to delivering behavioural therapy themselves, only 14% said they’d prefer not to do it.

So, what’s stopping the others? You guessed it: time, or lack thereof, is the main culprit. Time constraints were cited by 66% of GPs, while 32% said the remuneration isn’t enough for the time involved, and 20% said it’s not a good use of their time and resources.

GP psychotherapist Dr Susan Barnett, education chair of the Australian Society for Psychological Medicine (ASPM) says the system is not set up to support GPs administering these types of therapies.

“Psychologists have the time to do it, whereas GPs cannot financially afford to do this sort of work in our current Medicare system, unless they are billing a gap,” she says.

“For GPs, providing one minute of medicine is not equal over an hour. The GPs who do four consults an hour are financially more rewarded than those who do 30-to-45-minute appointments,” Dr Barnett says.

“And you cannot do focussed psychological strategies in 10- or 15-minute consults. So it simply comes down to cost, which is a real shame. That then means there’s a large proportion of people who miss out.”

GPs do use behavioural therapy, but probably don’t call it that

Still, while 47% of surveyed GPs said the main thing stopping them from delivering behavioural therapy was lack of knowledge or skill, many GPs are already using psychological strategies with their patients—but may not label it as such, Dr Barnett says.

For example, they might recommend behavioural activities like exercise, social connection, dietary changes, sleep hygiene, nature therapy, mindfulness, and smoking cessation.

“It’s all the healthy lifestyle things. So as whole-person care GPs, we already do it—and we do it across the lifespan. But we wouldn’t do it formally per se as a psychologist would do it.”

Focussed problem solving is another good example, she says.

This involves exploring the pros and cons of possible solutions to a problem. For example, if a patient is drinking excessively, you can used focussed problem solving to explore the options available—continue to drink as is, cut down, stop alcohol use—taking the person through the pros and cons of each, then letting them choose the best option in that moment.

This psychological tool is often used in general practice over many consults, Dr Barnett says, such as in smoking cessation.

“As a GP, we will continually enquire re smoking status over their lifetime. And it may take years for change to happen. However, this is what we do well.

“A lot of GPs wouldn’t think that’s behavioural therapy, but it is. It’s just done over a slower period.”

Training required to attract rebates for focussed psychological strategies

Dr Barnett stresses you do need additional training to provide focussed psychological strategies, noting the General Practice Mental Health Standards Collaboration offers a $600 grant for eligible GPs to do a course.

It’s worth doing the training even if you don’t want to become a provider of focussed psychological strategies, Dr Barnett says.

“It gives you a few more tools for working with your patients, even while you’re waiting for them to go and see a psychologist.”

Wait times can be a big barrier for patients seeking psychological care, with nearly six in 10 GPs in our survey reporting it takes a month or more for patients to get seen. Others said the cost could be prohibitive.

More effective than you might think

Dr Barnett stresses behavioural interventions can have a big impact.

“If we look at a depressed patient, get them exercising, get their sleep sorted, improve their diet, get them connecting socially and with nature, scheduling pleasurable activities—you’re going to get huge benefits.”

In patients who are suicidal, focussed problem solving can reduce their risk of dying by suicide, Dr Barnett says.

“When somebody is suicidal, they often feel trapped or hopeless and believe the only option is to end their life. And if we can teach our patients the skill of focussed problem solving, it can help them see the other options available to them,” Dr Barnett explains.

One meta-analysis of randomised clinical trials found problem-solving therapy could reduce suicide risk by 49%.

Many patients want psychological care from their GP

Although more than one in five surveyed GPs (22%) felt patients preferred to see another professional for behavioural therapy, Dr Barnett says many GPs undertake FPS training specifically because patients want them to provide psychological care—and they want more skills to offer those patients.

“And part of the reason is they feel safe enough to talk to the GP where they’ve got this amazing, trusting therapeutic relationship.”

The fact so many GPs don’t believe they can provide behavioural therapy demonstrates one of the ways GPs have been disempowered, she says, noting the therapeutic relationship accounts for 30% of recovery in mental health.

“But as many GPs have not undergone specific psychological skills training, they are not aware of how powerful the longstanding, trusting relationship is. You are often already a third of the way there.”

Courses in focussed psychological strategies

Australian Society for Psychological Medicine

RACGP