Mental Health Cases in KFP & Clinical Exams: A GP’s Guide to Mastering Mental Health Scenarios

Mental health is a cornerstone of general practice, yet often one of the most challenging areas for candidates preparing for the RACGP Key Feature Problem (KFP) and Clinical exams. With increasing emphasis on psychosocial care and early intervention, understanding how to approach mental health KFP cases and confidently handle GP mental health scenarios is essential for exam success, and clinical excellence.

In this article, we’ll break down common presentations like depression and anxiety in the RACGP exams, strategies for tackling them effectively, and key tips to impress examiners.

 

 

Why Mental Health Matters in KFP and Clinical Exams?

Mental health accounts for a significant portion of GP consultations in Australia. According to RACGP’s General Practice Health of the Nation report, over 60% of GPs report mental health as the most common patient presentation. Reflecting this real-world trend, mental health KFP cases and OSCE-style clinical encounters are a staple of the Fellowship exams.

Examiners want to see that you can:

• Take a structured and empathetic history,
• Formulate a working diagnosis,
• Manage risk (especially suicide risk),
• Create a practical and patient-centered management plan,
• Coordinate care with psychologists and psychiatrists when needed.

 

Common Mental Health KFP Case Patterns

Here are the most frequently seen KFP mental health cases:

1.    Depression in Adults

o   Presentations include low mood, anhedonia, sleep disturbance, and social withdrawal.

o   Key steps: Screen using PHQ-9, assess suicide risk, explore psychosocial stressors, and initiate a GP Mental Health Treatment Plan (MHTP) if appropriate.

2.    Anxiety Disorders

o   May present as generalised anxiety, panic attacks, or health anxiety.

o   Look for somatic symptoms like palpitations or insomnia.

o   Management includes psychoeducation, CBT referral, and possibly SSRIs like sertraline or escitalopram.

3.    Adolescent Mental Health

o   Includes school refusal, self-harm, and eating disorders.

o   Always involve parents or caregivers sensitively and consider HEADSSS assessment.

4.    Postnatal Depression

o   Often overlooked. Use Edinburgh Postnatal Depression Scale (EPDS).

o   Ensure mother and baby safety; involve perinatal mental health teams when needed.

5.    Suicidal Ideation

o   These cases test your ability to assess immediate risk.

o   Always perform a risk assessment (intent, plan, means, history), and document clearly.

o   Be prepared to initiate an involuntary mental health referral under state-based legislation if needed.

 

 

Approaching a Mental Health KFP Case

When attempting mental health KFP cases, follow a logical, evidence-based approach:

• Start with a focused history: Clarify mood symptoms, duration, triggers, substance use, and any past psychiatric history.
• Risk assessment is vital: Don’t skip suicide/self-harm risk, even if the stem doesn’t mention it.
• Investigations: Basic bloods (TSH, B12, iron studies) may be relevant to rule out medical causes.
• Management: Know the first-line SSRI options and when to refer.
• Follow-up: Always include safety-netting and review within 1-2 weeks, especially after initiating antidepressants.

 

GP Mental Health Scenarios in Clinical Exams (OSCE)

In the Clinical/OSCE-style exam (now part of the RACGP Clinical Competency Exam), GP mental health scenarios test your interpersonal and diagnostic skills.

These often include:

• A tearful patient presenting with fatigue and insomnia (hidden depression).
• A teenager brought in by a parent for behavioral changes (possible self-harm or bullying).
• A postpartum mother struggling to bond with her baby.

In these scenarios:

• Build rapport early, your empathy is being assessed.
• Use open-ended questions: “How have you been feeling emotionally?”
• Reflect and validate emotions: “That sounds incredibly difficult.”
• Summarize and negotiate the plan: “We have some great options to support you, would you be open to seeing a psychologist?”

 

 

Depression/Anxiety RACGP: What You Must Know

When studying depression/anxiety for RACGP exams, focus on:

• DSM-5 diagnostic criteria and how to apply them in primary care.
• First-line pharmacologic treatments: SSRIs, when to avoid benzodiazepines.
• Medicare items for mental health care: Know how and when to initiate a Mental Health Treatment Plan.
• Psychological therapies: When to refer to Better Access, Headspace, etc.
• When to refer: Consider psychiatrist involvement if risk is high or treatment-resistant.

Mastering mental health KFP cases, including depression and anxiety in RACGP exams, is not just about passing, it's about becoming a compassionate, competent GP. By understanding patterns, practicing case-based reasoning, and refining your communication, you’ll be ready to tackle any GP mental health scenario with confidence.