Finding the Right Path: Understanding Lunea's Three Care Pathways

When you are referred to Lunea, your care does not follow a one-size-fits-all template. Every woman who comes to us arrives with her own history, her own questions, and her own goals, so the way we structure your assessment is matched to what you actually need.

In practice, most referrals follow one of three pathways: the Standard Pathway, the Extended Pathway, or the 291 Pathway. The right one for you depends on the nature of what is going on, whether ongoing specialist input is likely to be helpful, and what your GP has requested in your referral.

Here is what each pathway involves, and how they differ.

How every Lunea journey begins

Whichever pathway you follow, the starting point is the same.

You will need a referral from your GP. Once we receive it, our clinical team reviews your information and confirms that Lunea is the right fit, and which pathway applies. We will then invite you to book, and all of your appointments take place online through a secure, private telehealth platform, wherever you are in Australia.

It is worth knowing up front that Lunea is an outpatient telehealth service. We are not able to provide crisis care or admissions and inpatient-level support. Ongoing care is offered within a shared-care model, working alongside your GP and any other treating clinicians.

The Standard Pathway

The Standard Pathway is our Comprehensive Psychiatric Assessment, completed over three sequential 45-minute appointments that together form the full diagnostic picture.

All three sessions are booked at the outset, ideally with the same clinician. We recommend spacing them around two weeks apart, with the full pathway completed within about eight weeks.

Across the three appointments you can expect:

• Appointment 1 - Comprehensive Psychiatric Assessment. A full clinical history, symptom review, and exploration of the factors contributing to how you are feeling. Your psychiatrist gathers detailed background information and clarifies your key concerns.

• Appointment 2 - Diagnostic Review. Remaining history taking, discussion of a diagnostic formulation, review of any collateral information, and there may be initial discussion about medication.

• Appointment 3 - Treatment Planning and Prescribing. A final diagnostic formulation, a tailored treatment plan, and, where appropriate, a discussion of medication options. This session also includes a collaborative decision about whether ongoing care at Lunea is suitable, or whether your GP will take over your management with a detailed handover.

The Extended Pathway

The Extended Pathway is our more in-depth assessment, used where a fuller evaluation and a longer first appointment are warranted. Like the Standard Pathway it runs over three sequential appointments, but with a longer first session: 60 minutes, then 45 minutes, then 45 minutes.

The most common reason for an Extended Pathway is a comprehensive psychiatric and ADHD assessment, and we have written a dedicated step-by-step guide to that process here: The Lunea ADHD Pathway: What to Expect, Step by Step. It is important to note, however, that not every Extended Pathway is an ADHD assessment. The longer format is used wherever a more detailed assessment is clinically appropriate.

The three appointments follow a similar shape to the Standard Pathway, with a longer first session:

• Appointment 1 (60 minutes) - Comprehensive Psychiatric Review. Where ADHD is being assessed, this longer session also covers a detailed ADHD history.

• Appointment 2 (45 minutes) - Discussion of Collateral and Diagnosis.

• Appointment 3 (45 minutes) - Treatment Planning.

We recommend spacing the appointments around two weeks apart, with the full pathway ideally completed within six to eight weeks.

Where your Extended Pathway includes an ADHD assessment, there is some preparation before you begin. About a week before your first appointment you will receive confidential online questionnaires to complete, which need to be returned at least 48 hours before the session, as the information is essential to your assessment. You will also receive a Physical Health Form for your GP to complete before Appointment 3, which supports safe prescribing if medication is being considered. Gathering collateral information, such as school reports or previous assessments, is also important: collateral is always required to confirm an ADHD diagnosis. Please be aware that an ADHD assessment is never a guarantee of an ADHD diagnosis. ADHD is explored carefully, and a diagnosis is made only where the evidence clearly supports it. Whatever the outcome, you will receive a tailored plan to support your mental health.

The 291 Pathway

The 291 Pathway is different in nature. Rather than the start of ongoing specialist care, it is a single, comprehensive, once-off psychiatric assessment, named after Medicare items 291 and 92435.

You attend one 60-minute consultation with your psychiatrist for a detailed psychiatric evaluation that clarifies diagnoses and sets out tailored treatment options. You and your GP then receive a full report, including your management plan, within two weeks of the appointment. That plan is designed to guide your GP-led care for the following 12 months, with your GP remaining your primary treating practitioner within the shared-care model.

A couple of practical points are worth knowing:

• Your GP needs to specifically request an item 291 assessment in your referral. If your GP would prefer the psychiatrist to take on ongoing treatment, a different referral applies.

• You should not have had a 291 assessment with any psychiatrist in the previous 12 months.

• Occasionally the information in a referral suggests complexity that is not appropriate for a once only appointment and a Medicare Item 291 may be declined on this basis, or an alternative pathway may be offered.

This makes the 291 Pathway a good option for women who want expert psychiatric input and a clear plan, but who do not need to see a psychiatrist on an ongoing basis.

Which pathway is right for me?

The good news is that you do not have to work this out on your own. Your GP, together with our clinical team, will determine the most appropriate pathway when your referral is reviewed. The table below gives an at-a-glance comparison.

	Standard Pathway	Extended Pathway	291 Pathway
Structure	3 appointments (45 + 45 + 45 min)	3 appointments (60 + 45 + 45 min)	Single appointment (60 min)
Best suited to	A thorough psychiatric assessment	A more in-depth assessment, including ADHD assessment	A once-off assessment and management plan
Preparation	None specific	Questionnaires, collateral, and a GP health form where ADHD is assessed	None
What your GP receives	A plan and, where relevant, a handover	A plan and, where relevant, a handover	A detailed report and 12-month plan within 2 weeks
Ongoing care	Decided collaboratively at Appointment 3	Decided collaboratively at Appointment 3	Not part of this pathway; your GP continues care

One practical tip for GPs: if you are unsure whether a 291 assessment is the right call, you can note in the referral something to the effect of "for assessment and management under item 291 if appropriate," and the psychiatrist can confirm the most suitable approach at the time of consultation.

Useful links

• Schedule of fees

• The Lunea ADHD Pathway: What to Expect, Step by Step

A note on care, not just process

Pathways and item numbers are the scaffolding, not the substance. Whichever route you take, the experience we want you to have is the same: a thorough, understanding assessment, a personalised plan, and the sense that you have been heard and believed.