A coroner has recommended changes to Medicare to provide better support for Australians struggling with mental health after the deaths of a Melbourne mother and daughter.
Aisha Beck killed her three-year-old daughter Azizak before taking her own life in January 2017 in the midst of a psychosis.
Mrs Beck and her husband Mohamed went through IVF to conceive the little girl after struggling for several years and welcomed her arrival in April 2013.
Two years later Mrs Beck received inpatient mental health treatment and was prescribed anti-psychotic medication after telling neighbours that she had "just given birth to Jesus" and requested they call Tony Abbott and the Norwegian Embassy.
She was later referred to a psychologist after relapsing and expressing suicidal and homicidal thoughts to her husband, a GP and her neighbour in early 2016.
Mrs Beck had said she would take her daughter's life with her own. As a child in Myanmar she had discovered her own mother's body, which caused her significant ongoing post-traumatic symptoms.
In late 2016 she received a letter from Centrelink advising her that she defrauded them of $23,000, which Mr Beck said had caused her significant distress.
Victorian Deputy State Coroner Caitlin English said in findings on Wednesday that Mr Beck had taken a seven-month leave of absence from work to support his wife in the lead-up to her death.
He returned to work on January 23, something he said his wife had been concerned about because it meant she had to leave the house to pick up their daughter from kindergarten.
Mrs Beck had no family or friends in Australia. She would occasionally see a neighbour but worried about imposing.
Mr Beck said his wife had also stopped her medication at that time, but told him she "felt fine".
When he arrived home from work on January 29 he noticed it was strange that Aziza didn't come running to greet him as she usually did.
He found the bodies of his wife and daughter in their living room.
Mrs Beck had a mental health management plan, but Ms English noted she would have benefited from a more detailed one that took into account social and psychological aspects.
Ms English said Australians visited GPs for mental health issues approximately 18 million times in 2015-16, when Mrs Beck first sought help.
But only 3.2 million mental health specific GP services were subsidised by Medicare.
Ms English said the Medicare system does not support mental health consultations lasting more than 40 minutes.
The Royal Australian College of GPs has noted that the inconsistency is caused by GPs billing them as longer consultations rather than using mental health specific codes.
Ms English said mental health services need to be supported by Medicare and billing item numbers need to reflect the complexity of services provided by GPs.
She has endorsed RACGP proposals to introduce new billing item numbers that do so, and recommended the federal government consider proposals to add new item numbers for longer sessions and funding for telehealth consultations for those on psychotropic medications.
Ms English also noted the current model of care does not encourage or facilitate assertive follow-up by GPs if patients stop attending appointments.
She recommended the RACGP issue or update guidelines for doctors to include flags or alerts in their patient systems for those who need repeat prescriptions or mental health review.
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Australian Associated Press