Counselling Skills

📋 Key Information Summary

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GP as counsellor: General practitioners are often the first point of contact for patients experiencing psychological distress; integrating counselling skills into routine consultations improves patient outcomes and reduces stigma.
Cognitive Behavioural Therapy (CBT): The most extensively evidence-based counselling model applicable in general practice; effective for depression, anxiety, insomnia, and chronic pain — can be delivered in brief, structured sessions of 6–20 sessions.
Motivational Interviewing (MI): A collaborative, patient-centred counselling style particularly useful for behaviour change (smoking cessation, alcohol reduction, medication adherence); uses the OARS technique (Open questions, Affirmations, Reflective listening, Summarising).
Brief intervention models: The 5As framework (Ask, Assess, Advise, Assist, Arrange) and FRAMES (Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy) are practical for time-limited GP consultations.
Crisis management: Immediate risk assessment using the SAD PERSONS scale or Columbia Suicide Severity Rating Scale (C-SSRS); stabilise, ensure safety, and arrange follow-up within 24–48 hours.
Bereavement: Normal grief is a continuum — most patients benefit from validation, psychoeducation, and watchful waiting; complicated grief (prolonged grief disorder) requires specialist referral and may respond to CBT or interpersonal therapy.
Breaking bad news: Use the SPIKES protocol (Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary); Australian patients value honesty, empathy, and shared decision-making.
Psychotherapy types: GPs should understand CBT, interpersonal therapy (IPT), acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT) skills, psychodynamic therapy, and narrative therapy to facilitate appropriate referral.
Mental Health Treatment Plans (MHTP): Medicare items 2710/2712 allow GPs to refer patients for up to 10 sessions per calendar year (plus 10 additional in exceptional circumstances via review) with a psychologist under Medicare Benefits Schedule (MBS) item 80010/80011.
Aboriginal and Torres Strait Islander considerations: Yarning-based counselling, culturally safe practice, acknowledgement of intergenerational trauma, and integration with social and emotional wellbeing (SEW) frameworks are essential.
Safety net: Always assess for risk of self-harm or harm to others before initiating counselling; document safety plans and emergency contacts.
GP mental health skills training: RACGP and GPMHSC-accredited skills training (Focussed Psychological Strategies — FPS) enables GPs to deliver Medicare-rebatable psychological interventions.

Introduction & Australian Epidemiology

Counselling skills are a core competency for Australian general practitioners. With approximately 20% of all GP encounters involving mental health concerns, and over 16 million mental health-related GP visits recorded annually by the Bettering the Evaluation and Care of Health (BEACH) programme and successor data collections, the GP is uniquely positioned to deliver early psychological intervention, brief counselling, and structured psychotherapy within the primary care setting.

The Australian Institute of Health and Welfare (AIHW) reports that mental health and substance use disorders affect an estimated 4.4 million Australians (approximately 17% of the population) in any given year. Anxiety disorders, depressive disorders, and substance use disorders are the most frequently managed conditions in general practice. Despite the availability of specialist mental health services, access barriers — particularly in rural and remote areas, Aboriginal and Torres Strait Islander communities, and culturally and linguistically diverse (CALD) populations — mean that GPs frequently serve as de facto counsellors, crisis responders, and long-term therapeutic allies.

This article reviews the counselling models, crisis management strategies, protocols for breaking bad news, and psychotherapy approaches that are most applicable to Australian general practice. It is written to support the GP in delivering evidence-based, culturally safe, and Medicare-compliant psychological care.

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Key statistics: Suicide remains the leading cause of death for Australians aged 15–44 years. In 2022, 3,249 Australians died by suicide (ABS Causes of Death data). Aboriginal and Torres Strait Islander peoples die by suicide at approximately twice the rate of non-Indigenous Australians.

The GP's Role in Mental Health Care

Under the Australian Government's Better Access to Mental Health Care initiative, GPs can prepare Mental Health Treatment Plans (MHTPs) enabling patients to access subsidised psychological services. GPs who have completed Focussed Psychological Strategies (FPS) training through the General Practice Mental Health Standards Collaboration (GPMHSC) are additionally authorised to deliver structured psychological interventions under MBS items 2710, 2712, 2713, and 2715.

The role of the GP-counsellor encompasses: early identification of psychological distress, risk assessment, brief intervention, structured psychotherapy (within FPS scope), coordination with psychologists and psychiatrists, and ongoing supportive counselling during chronic mental health conditions.

Counselling Models (Including CBT)

Several counselling models are applicable within the general practice setting. The choice of model depends on the patient's presentation, the GP's training, available time, and the therapeutic goals. The models below represent the most evidence-based and commonly used approaches in Australian primary care.

1. Cognitive Behavioural Therapy (CBT)

CBT is the most extensively validated psychotherapeutic model and forms the backbone of Focussed Psychological Strategies (FPS) training for Australian GPs. It is based on the principle that maladaptive cognitions (thoughts, beliefs, attitudes) and behaviours maintain psychological distress, and that systematic modification of these cognitions and behaviours produces symptom improvement.

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Evidence base: CBT has Level I evidence (systematic reviews and meta-analyses) for major depressive disorder, generalised anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, insomnia, chronic pain, and eating disorders (NICE 2022; RACGP Green Book 2020).

Core CBT Techniques for GPs

Technique	Description	Application in GP
Cognitive restructuring	Identifying and challenging negative automatic thoughts and cognitive distortions	Thought diaries, Socratic questioning during follow-up consults
Behavioural activation	Scheduling pleasurable and mastery activities to counteract withdrawal and avoidance	Activity scheduling worksheets; particularly effective for depression
Graded exposure	Systematic, hierarchical confrontation of feared stimuli	Anxiety disorders, phobias; can be initiated in GP and continued with psychologist
Problem-solving therapy	Structured approach to identifying problems, generating solutions, and implementing plans	Brief interventions (4–6 sessions); suits time-limited GP consults
Psychoeducation	Teaching the patient about their condition, the CBT model, and self-management strategies	Foundation of every CBT-informed GP consultation
Relaxation and mindfulness	Diaphragmatic breathing, progressive muscle relaxation, mindfulness-based techniques	Anxiety, insomnia, chronic pain; can be taught in 10 minutes
Sleep hygiene and stimulus control	Restricting bed to sleep; eliminating incompatible behaviours; sleep scheduling	Insomnia — often preferable to pharmacotherapy as first-line

CBT Session Structure for General Practice

1

Agenda setting (2–3 min)

Collaboratively set the session agenda; review homework and mood ratings.

2

Mood check (2–3 min)

Use PHQ-9 or K-10 to track symptoms over time; graph progress.

3

Core work (10–15 min)

Identify a specific cognitive or behavioural target; apply restructuring, exposure, or activation techniques.

4

Homework and summary (3–5 min)

Set between-session tasks; summarise key learnings; confirm next appointment.

2. Motivational Interviewing (MI)

Motivational interviewing is a directive, client-centred counselling style developed by Miller and Rollnick that aims to elicit behaviour change by helping the patient explore and resolve ambivalence. It is particularly valuable in general practice for addressing lifestyle-related conditions (smoking, alcohol, obesity, physical inactivity) and medication non-adherence.

The OARS Technique

O — Open-ended questions: "What concerns you most about your drinking?"
A — Affirmations: "It took courage to come in today and talk about this."
R — Reflective listening: "It sounds like you're torn between wanting to cut down and feeling that alcohol helps you cope."
S — Summarising: "So what I'm hearing is…"

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Avoid the "righting reflex": GPs are trained to give advice, but in MI, premature advice-giving can increase resistance. Instead, guide the patient to articulate their own reasons for change.

3. Person-Centred (Rogerian) Counselling

Developed by Carl Rogers, person-centred counselling rests on three core conditions: unconditional positive regard, empathic understanding, and congruence (genuineness). While not a structured therapy, these conditions underpin all effective therapeutic relationships in general practice and are essential for building rapport, particularly with patients experiencing grief, relationship difficulties, or existential distress.

4. Solution-Focused Brief Therapy (SFBT)

SFBT is a future-oriented, goal-directed model that focuses on solutions rather than problems. Key techniques include the "miracle question" ("If you woke up tomorrow and the problem was gone, what would be different?"), scaling questions (e.g., "On a scale of 0–10, where are you now?"), and identifying exceptions to the problem. SFBT is particularly suited to the time constraints of general practice and can be effective in as few as 1–3 sessions.

5. Narrative Therapy

Narrative therapy externalises the problem ("The depression tells you that you're worthless — but is that your story?") and helps patients re-author their life narratives. Developed by Michael White and David Epston (Adelaide/New Zealand), it is culturally adaptable and has been widely adopted in Australian mental health services, particularly with Aboriginal and Torres Strait Islander communities and CALD populations.

Crisis Management & Bereavement

Crisis Assessment in General Practice

A mental health crisis is any situation in which a person's usual coping mechanisms are overwhelmed, placing them at risk of self-harm, harm to others, or acute psychological decompensation. In Australian general practice, crises commonly include suicidal ideation or attempt, acute psychosis, severe panic attacks, domestic violence disclosure, and acute grief reactions.

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Safety first: If a patient presents with active suicidal ideation with a plan and intent, do not leave them alone. Contact emergency services (000), arrange urgent psychiatric assessment, or transfer to the nearest emergency department. In most Australian states, involuntary assessment can be initiated under Mental Health Act legislation if the patient refuses.

Suicide Risk Assessment

Use a structured approach to assess suicide risk. The following tools are validated and commonly used in Australian primary care:

Tool	Description	Use
Columbia Suicide Severity Rating Scale (C-SSRS)	Structured interview assessing ideation severity and behaviour	Gold standard for suicide risk assessment; freely available at cssrs.columbia.edu
SAD PERSONS Scale	10-item mnemonic: Sex, Age, Depression, Previous attempt, Ethanol abuse, Rational thinking loss, Social supports lacking, Organised plan, No spouse, Sickness	Rapid screening; score ≥7 suggests high risk requiring urgent intervention
PHQ-9 Item 9	"Over the last 2 weeks, how often have you been bothered by thoughts that you would be better off dead, or of hurting yourself?"	Screening during routine depression monitoring; any positive response requires further assessment

The GP Crisis Management Framework

1

Ensure safety

Remove means (medications, sharps); do not leave the patient alone; involve a practice nurse or reception staff for supervision.

2

Assess risk

Use C-SSRS or SAD PERSONS. Determine ideation, plan, intent, and means. Identify protective factors.

3

Stabilise and support

Validate the patient's distress. Use grounding techniques. Offer short-term coping strategies. Consider short-term anxiolytic if appropriate.

4

Create a safety plan

Collaborative written plan: warning signs, coping strategies, people to contact, crisis numbers (Lifeline 13 11 14, Beyond Blue 1300 22 4636, 000).

5

Arrange follow-up

Next appointment within 24–48 hours. Refer to crisis team (e.g., CATT/CRCT) if needed. Notify the patient's nominated supports with consent.

Bereavement and Grief

Grief is a natural response to loss. Most bereaved individuals experience a pattern of emotional, cognitive, physical, and behavioural responses that gradually resolve with the support of family, friends, and their GP. However, a significant minority (estimated 7–10%) develop Prolonged Grief Disorder (PGD), now recognised in DSM-5-TR and ICD-11, characterised by persistent, intense yearning and preoccupation with the deceased lasting more than 12 months (6 months in ICD-11) with marked functional impairment.

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Red flags in bereavement: Persistent suicidal ideation, severe functional impairment beyond 3 months, inability to accept the reality of the death, intense guilt unrelated to the death, extreme social withdrawal, or substance misuse escalation should prompt referral for specialist grief counselling or psychiatric assessment.

GP Approach to Bereaved Patients

Validate normal grief: "What you're feeling is a normal response to losing someone you love."
Psychoeducation: Explain the grief trajectory — denial, anger, bargaining, depression, acceptance (Kübler-Ross model) — while noting that grief is non-linear.
Watchful waiting: Schedule regular follow-ups (2–4 weekly) to monitor adjustment.
Address complications: Screen for depression (PHQ-9), anxiety (GAD-7), and substance misuse.
Anticipatory grief: When death is expected (e.g., terminal illness), support the family through anticipatory grief with advance care planning discussions.
Referral pathways: Grief Australia, state-based bereavement services, Palliative Care Australia, private psychologists specialising in grief.

Pharmacotherapy Considerations in Grief

Routine use of benzodiazepines or antidepressants is not recommended for normal grief. Antidepressants (e.g., sertraline 50 mg PO daily) should be considered only when major depressive disorder criteria are met. Short-term benzodiazepines (e.g., temazepam 10 mg PO nocte for ≤7 days) may be considered for severe insomnia, but with caution regarding dependence risk.

Breaking Bad News

Breaking bad news is one of the most challenging communication tasks in general practice. "Bad news" encompasses any information that negatively alters a patient's expectations about their future — including a new diagnosis of cancer, chronic disease, a poor prognosis, or results indicating a genetic condition. Australian research consistently shows that patients value honesty, empathy, adequate time, and the opportunity to ask questions.

The SPIKES Protocol

The SPIKES protocol (Buckman 2005) is the most widely taught and validated framework for delivering bad news. It is endorsed by the RACGP and is a core component of Australian GP training communication skills assessments.

S

Setting

Ensure a private, quiet environment. Sit down. Turn off your phone. Ensure no interruptions. Invite the patient to bring a support person. Have tissues available.

P

Perception

Assess what the patient already knows or suspects. "Can you tell me what you understand about why we did the tests?" This prevents premature disclosure and identifies misconceptions.

I

Invitation

Ask how much the patient wants to know. "Would you like me to go through the results in detail, or would you prefer I give you the main points?" Respect autonomy — some patients prefer not to know everything.

K

Knowledge

Deliver the information in plain language. Use a "warning shot": "I'm afraid the results are not what we hoped." Pause after each key piece of information. Avoid jargon. Check understanding frequently.

E

Emotions

Acknowledge and validate the patient's emotional response. "I can see this is very upsetting." Use empathic silence. Do not rush to "fix" the emotion — presence is the intervention.

S

Strategy & Summary

Outline the next steps: referrals, additional tests, treatment options. Offer a written summary. Arrange a follow-up appointment within days. Ask: "What questions do you have?" — avoid "Do you have any questions?" (which invites a "no").

Practical Tips for Australian GPs

Telephone bad news: Avoid delivering critical results by phone where possible. If unavoidable, ensure the patient is in a safe environment, confirm their identity, and arrange face-to-face follow-up within 24–48 hours.
Cultural considerations: Some Aboriginal and Torres Strait Islander patients may prefer family involvement and a less direct communication style. Use "yarning" approaches and allow silence.
CALD patients: Arrange professional interpreters (not family members) for patients with limited English proficiency. The TIS National (Translating and Interpreting Service) provides free interpreting for Medicare-eligible consultations — phone 131 450.
Children and adolescents: Tailor language to developmental stage. Involve parents/carers but also speak directly to the young person.
Documentation: Record what was communicated, the patient's reaction, who was present, and the agreed plan. This has both clinical and medicolegal importance.

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Self-care for the GP: Regularly breaking bad news contributes to compassion fatigue and burnout. Engage in reflective practice, debrief with colleagues, and utilise GP support programmes such as the Doctors' Health Advisory Service (state-based helplines) and Avant's GP wellbeing resources.

Types of Psychotherapy

Understanding the major psychotherapy modalities enables GPs to provide informed referrals, offer initial psychoeducation, and, where FPS-trained, deliver selected interventions directly. The following table summarises the principal psychotherapy types relevant to Australian general practice.

Therapy	Core Principles	Best Indications	GP Applicability
Cognitive Behavioural Therapy (CBT)	Thoughts, feelings, and behaviours are interconnected; modify maladaptive cognitions and behaviours	Depression, GAD, panic, OCD, PTSD, insomnia, chronic pain	⭐⭐⭐ Core FPS strategy; GPs can deliver 6–20 session courses
Interpersonal Therapy (IPT)	Focuses on interpersonal relationships and social functioning as drivers of mood disorders	Major depression (especially situational), bulimia nervosa	⭐⭐ FPS strategy; structured 12–16 sessions addressing role disputes, transitions, grief, interpersonal deficits
Acceptance & Commitment Therapy (ACT)	Psychological flexibility; acceptance of unwanted internal experiences; commitment to values-based action	Chronic pain, anxiety, depression, adjustment disorders, tinnitus	⭐⭐ FPS strategy; can be delivered in brief sessions; uses metaphors and experiential exercises
Dialectical Behaviour Therapy (DBT) Skills	Distress tolerance, emotional regulation, interpersonal effectiveness, mindfulness	Borderline personality disorder, emotional dysregulation, recurrent self-harm	⭐ GPs can teach DBT skills (e.g., TIPP for crisis survival) but full DBT requires specialist services
Psychodynamic/Psychoanalytic Therapy	Unconscious processes, early life experiences, defence mechanisms, therapeutic relationship as vehicle for change	Personality disorders, complex trauma, recurrent depression, relationship difficulties	⭐ Requires specialist training; long-term; refer to clinical psychologists or psychiatrists
Narrative Therapy	Externalising problems; re-authoring life stories; identifying unique outcomes and preferred narratives	Trauma, cultural dislocation, grief, identity issues	⭐⭐ Culturally adaptable; useful with Aboriginal and Torres Strait Islander and CALD patients
Eye Movement Desensitisation & Reprocessing (EMDR)	Bilateral stimulation to facilitate reprocessing of traumatic memories	PTSD, complex trauma	⭐ Requires specialist trained therapist; refer to EMDRAA-accredited practitioners
Mindfulness-Based Cognitive Therapy (MBCT)	Combines CBT with mindfulness meditation to prevent depressive relapse	Recurrent depression (≥3 episodes), residual symptoms	⭐⭐ Typically group-based; 8-week programme; available through some community mental health services
Family/Systemic Therapy	Addresses relational patterns within family systems; genograms; circular questioning	Child and adolescent mental health, eating disorders, family conflict, domestic violence	⭐ Refer to family therapists; GPs can use systemic thinking in formulation

Focussed Psychological Strategies (FPS) — What GPs Can Deliver

FPS-trained GPs (having completed GPMHSC-accredited training) can deliver the following under Medicare, using MBS items 2710 (standard) and 2712 (long consultation):

Psychoeducation
Cognitive behaviour therapy (CBT)
Relaxation strategies
Skills training (anger management, social skills, communication)
Interpersonal therapy (IPT)
Narrative therapy
Motivational interviewing
Acceptance and commitment therapy (ACT)

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MBS billing note: FPS items (2700, 2701, 2715, 2717) are distinct from MHTP-related psychologist referral items (2710, 2712). FPS consultations are billed by the GP delivering the therapy; psychologist sessions are billed under the psychologist's provider number using MBS items 80010 or 80011. Patients may access both simultaneously.

Pharmacotherapy in Context

While counselling and psychotherapy are the focus of this article, medication often plays an adjunctive role. Key considerations include:

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Sertraline

Zoloft® · Generic · SSRI

Adult dose 50 mg PO daily, titrate to 100–200 mg daily

Paediatric dose ≥6 years: 25 mg PO daily for OCD; titrate to 50–200 mg daily

Renal adjustment No adjustment required

PBS status ✔ PBS General Benefit

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Escitalopram

Lexapro® · Generic · SSRI

Adult dose 10 mg PO daily, max 20 mg daily

Paediatric dose ≥12 years: 10 mg PO daily (MDD)

Renal adjustment No adjustment; caution in severe impairment

PBS status ✔ PBS General Benefit

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Venlafaxine XR

Effexor-XR® · Generic · SNRI

Adult dose 75 mg PO daily, titrate to 150–225 mg daily

Paediatric dose Not recommended <18 years

Renal adjustment eGFR 10–30: reduce dose by 50%

PBS status ✔ PBS General Benefit

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Black box warning: SSRIs and SNRIs carry a TGA warning regarding increased risk of suicidal ideation in children, adolescents, and young adults (<25 years). Close monitoring (weekly for the first 4 weeks) is mandatory when initiating antidepressants in this age group.

Special Populations

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Pregnancy & Postnatal

Screening: Edinburgh Postnatal Depression Scale (EPDS) at antenatal booking (≈12 weeks), 6 weeks postnatal, and 6–12 months postnatal — MBS item 70609 funds this screening.

Perinatal mental health: Anxiety and depression affect up to 1 in 5 women during pregnancy and the postnatal period. Perinatal anxiety is now recognised as equally prevalent as depression.

Counselling: CBT and IPT are safe and effective in pregnancy; should be first-line before pharmacotherapy where possible.

Sertraline — preferred SSRI in breastfeeding (low breast milk transfer).

Refer to perinatal mental health services for severe presentations; contact PANDA (Perinatal Anxiety & Depression Australia) helpline: 1300 726 306.

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Paediatrics & Adolescents

Age-appropriate techniques: Use play therapy concepts with younger children; CBT is effective from age 7+ with developmental adaptations.

Adolescents: Motivational interviewing and ACT are particularly effective. Address confidentiality boundaries — explain limits (safety concerns, mandatory reporting).

Referral thresholds: Refer to CAMHS (Child and Adolescent Mental Health Services) for presentations beyond GP scope: psychosis, severe eating disorders, significant self-harm, complex trauma.

Headspace: Free youth mental health services for 12–25 year olds — 150+ centres nationally plus online (eheadspace.org.au).

Medicare items 2700/2701 available for FPS in patients <18 years (no MHTP required).

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Older Adults

Screening tools: GDS-15 (Geriatric Depression Scale) is validated for use in older adults and avoids somatic items that may confound in medical illness.

Counselling adaptations: Problem-solving therapy and reminiscence therapy are evidence-based for late-life depression. CBT is effective but may require session lengthening and repetition.

Grief: Older adults experience multiple losses (spouse, peers, health, independence). Validate cumulative grief.

Avoid TCAs in the elderly due to anticholinergic effects, falls risk, and cardiac conduction issues.

Distinguish depression from dementia (pseudodementia). Consider cognitive screening (MoCA/MMSE) alongside mood assessment.

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Renal Impairment

Preferred antidepressants: Sertraline and mirtazapine have the least renal dosing concerns. Venlafaxine requires dose reduction at eGFR <30.

Benzodiazepines: Avoid diazepam (active metabolites accumulate); use lorazepam if required (hepatically metabolised, no active metabolites).

Counselling access: Patients on dialysis have high rates of depression (prevalence 20–40%). Advocate for psychology services within renal units.

MHTP-funded psychologist sessions are available for CKD patients — ensure referral is in place.

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Immunocompromised

Psychological burden: HIV, transplant recipients, and patients on biologic immunosuppression carry significant psychological burden including stigma, health anxiety, and adjustment difficulties.

Drug interactions: SSRIs (particularly fluoxetine, paroxetine) inhibit CYP2D6 — check interactions with antiretrovirals and immunosuppressants (tacrolimus, cyclosporine).

Counselling focus: ACT is particularly suited to chronic immunocompromised states — emphasis on acceptance, values, and committed action in the context of medical uncertainty.

Coordinate with the treating specialist (infectious disease, transplant physician) when initiating psychotropic medications.

Monitoring & Outcome Measurement

Systematic monitoring of patient outcomes is essential for effective counselling in general practice. Routine use of validated outcome measures guides treatment decisions, documents progress, and satisfies MHTP review requirements.

Recommended Screening and Outcome Tools

Tool	Measures	Administration	Frequency
PHQ-9	Depression severity (0–27)	Self-report; 9 items; 2–5 min	Baseline, then every 2–4 weeks during treatment
GAD-7	Generalised anxiety severity (0–21)	Self-report; 7 items; 2–3 min	Baseline, then every 2–4 weeks
K-10	Psychological distress (10–50)	Self-report; 10 items; 2–5 min	Baseline and at MHTP review (minimum 6-monthly)
DASS-21	Depression, anxiety, and stress	Self-report; 21 items; 5 min	Baseline and every 4 weeks
WHO-5 Well-Being Index	Positive wellbeing (0–25)	Self-report; 5 items; 1–2 min	Useful as a positive framing tool alongside distress measures
C-SSRS	Suicidal ideation and behaviour	Clinician-administered; variable length	At every risk assessment; repeated as clinically indicated

When to Refer to Specialist Services

No improvement after 6–8 sessions of GP-delivered FPS
PHQ-9 score ≥20 (severe depression) at baseline or worsening despite treatment
Active suicidal ideation with plan and intent
Suspected personality disorder requiring specialist assessment
Psychotic symptoms (hallucinations, delusions, thought disorder)
Significant substance use disorder requiring detoxification or rehabilitation
Complex trauma or PTSD requiring EMDR or intensive trauma-focused therapy
Eating disorders with BMI <17 or medical instability

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Key referral pathways: Beyond Blue (1300 22 4636), Lifeline (13 11 14), Kids Helpline (1800 55 1800), SANE Australia (1800 18 7263), headspace (for 12–25 years), state-based Community Mental Health Teams, and private psychologists via the Australian Psychological Society (APS) "Find a Psychologist" directory.

Aboriginal and Torres Strait Islander Health Considerations

Aboriginal and Torres Strait Islander Health

Aboriginal and Torres Strait Islander peoples experience significantly higher rates of psychological distress, suicide, and social and emotional wellbeing (SEW) concerns compared to non-Indigenous Australians. The intergenerational effects of colonisation, the Stolen Generations, forced removals, systemic racism, and ongoing socioeconomic disadvantage are fundamental contributors to mental health disparities. Counselling in this context must be culturally safe, trauma-informed, and grounded in the social and emotional wellbeing framework rather than a purely biomedical model.

Historical trauma

Intergenerational trauma from colonisation, Stolen Generations, and forced removals underlies much of the psychological distress observed. GPs must acknowledge this context and approach counselling with cultural humility and recognition of collective grief.

Social and emotional wellbeing (SEW)

The SEW framework recognises that wellbeing is determined by connection to body, mind, family, community, culture, Country, and spirituality. Western counselling models (e.g., CBT) may need adaptation to incorporate these domains. Therapeutic approaches that centre on "story" and "yarning" are often more effective.

Yarning-based counselling

"Yarning" is a culturally embedded communication style that includes collaborative yarning (working together), therapeutic yarning (healing through story), and research yarning. GPs can integrate therapeutic yarning into counselling — using non-linear, circular conversation that respects Indigenous communication styles rather than rigid session agendas.

Stigma and shame

Mental health stigma can be particularly strong in some Aboriginal and Torres Strait Islander communities. Framing counselling as "having a yarn" or "looking after your SEW" rather than "therapy" may reduce barriers to engagement.

Remote and rural access

Aboriginal and Torres Strait Islander peoples in remote and very remote areas have limited access to psychologists and psychiatrists. GPs and Aboriginal Health Workers/Practitioners (AHW/AHP) may be the only available counsellors. Telehealth psychology services (Medicare-funded via videoconference) can partially bridge this gap.

Aboriginal Health Workers & Practitioners

AHWs and AHPs are essential members of the mental health team. They provide culturally safe support, link patients with community resources, and can deliver brief SEW interventions. GPs should actively collaborate with AHWs in care planning and counselling.

Crisis and suicide prevention

Aboriginal and Torres Strait Islander suicide rates are approximately twice the national rate, with rates among young people (15–24 years) being particularly alarming. Community-led suicide prevention programmes (e.g., Alive and Kicking Goals! in Broome, Breakthrough for Families) should be supported. The 13YARN crisis support line (13 92 76) is staffed by Aboriginal and Torres Strait Islander crisis counsellors.

Culturally appropriate referral

Prioritise Aboriginal Community Controlled Health Organisations (ACCHOs) and Indigenous-specific mental health programmes. The Australian Indigenous Doctors' Association (AIDA) and the National Aboriginal Community Controlled Health Organisation (NACCHO) provide directories of culturally safe services.

📚 References

1. Royal Australian College of General Practitioners (RACGP). Mental health. In: RACGP Curriculum: General Practice. Melbourne: RACGP; 2023.
2. General Practice Mental Health Standards Collaboration (GPMHSC). Focussed Psychological Strategies Skills Training. Melbourne: GPMHSC; 2023. Available from: gpmhsc.org.au.
3. Australian Institute of Health and Welfare (AIHW). Mental health services in Australia. Canberra: AIHW; 2023. Cat. no. HSE 262.
4. Australian Bureau of Statistics (ABS). Causes of Death, Australia, 2022. Canberra: ABS; 2023. Cat. no. 3303.0.
5. Buckman RA. Breaking bad news: the S-P-I-K-E-S strategy. Community Oncology. 2005;2(2):138–142.
6. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York: Guilford Press; 2013.
7. National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NICE guideline [NG222]. London: NICE; 2022 (updated 2024).
8. National Institute for Health and Care Excellence (NICE). Generalised anxiety disorder and panic disorder in adults: management. NICE guideline [CG113]. London: NICE; 2020 (updated 2024).
9. Gee G, Dudgeon P, Schultz C, Hart A, Kelly K. Aboriginal and Torres Strait Islander social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R, editors. Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. 2nd ed. Canberra: Commonwealth of Australia; 2014. p. 55–68.
10. Dudgeon P, Milroy H, Walker R, editors. Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. 2nd ed. Canberra: Commonwealth of Australia; 2014.
11. Services Australia. Mental Health Treatment Plan — MBS items 2700, 2701, 2710, 2712, 2713, 2715, 2717. Canberra: Australian Government; 2024. Available from: mbsonline.gov.au.
12. Prigerson HG, et al. Prolonged grief disorder: refining the research criteria for DSM-5-TR and ICD-11. Psychological Medicine. 2021;51(12):2006–2013.
13. Australian Psychological Society (APS). Evidence-based psychological interventions in the treatment of mental disorders: A literature review. 4th ed. Melbourne: APS; 2018.
14. Posner K, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings. Am J Psychiatry. 2011;168(12):1266–1277.
15. Bandler S, et al. 13YARN — culturally safe crisis support for Aboriginal and Torres Strait Islander peoples. Australasian Psychiatry. 2023;31(2):145–148.