Mental health
Mental health
This domain covers recognition, risk assessment, first-line treatment and the statutory boundaries of involuntary care. The commonest error is under-documenting risk or over-relying on a questionnaire score.
Core rules
- Structured assessment: mental state examination (appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition, insight) plus a biopsychosocial history and substance use screen.
- Validated measures support but do not replace interview: PHQ-9, GAD-7, K10, and the Edinburgh Postnatal Depression Scale in the perinatal period.
- Risk assessment: ask directly about suicidal ideation, intent, plan, means, previous attempts, and protective factors; document the formulation and the safety plan. Passive ideation without plan or intent allows community care with close review; intent with a plan and means requires urgent escalation.
- Treatment: for moderate-to-severe depression, psychological therapy plus or minus an antidepressant (SSRI first-line). MBS items exist for a GP Mental Health Treatment Plan and review, and a separate pathway applies to eating disorders.
- Involuntary treatment is governed by state and territory mental health legislation and requires risk to self or others, or significant deterioration, plus likely benefit from treatment.
Worked example
A 42-year-old presents with three weeks of low mood, poor sleep and anhedonia. PHQ-9 is 18. He denies a plan and says his children are the reason he keeps going, but admits fleeting thoughts of “not being here”.
Reasoning: moderate-to-severe depression with passive ideation, protective factors present, no plan or intent. Plan: complete a mental health treatment plan, start an SSRI with discussion of early side effects, arrange psychological therapy, produce a written safety plan with crisis numbers, and review within one to two weeks. Same-day crisis referral is not required but would be if a plan or means emerged.
Traps that cost marks
- Relying on the PHQ-9 score alone without assessing risk.
- Failing to ask about alcohol or other drugs.
- Not documenting the risk formulation.