Research Reprinted from AJGP Vol. 52, No. 8, August 2023 567 © The Royal Australian College of General Practitioners 2023 Pattern of mental health attendances at a metropolitan university general practice clinic in Sydney before and during the COVID-19 pandemic Vivien Nguyen, Tim Tse, Simon Willcock, Sanjyot Vagholkar, Bosco Wu Background and objective The aim of this study was to describe the pattern of mental health attendances in a university-based general practice clinic during phases of the COVID-19 pandemic. The COVID-19 pandemic has created social and medical disruptions to the Australian community. There is a literature gap pertaining to the ongoing trends that extend beyond the initial ‘first wave’ of the pandemic in the context of the Australian landscape. Methods Retrospective data were obtained from 435 adults attending a community university-based general practice in Sydney, Australia, during four time periods: T1, before the COVID-19 pandemic (1 February – 7 March 2019); T2, during the first COVID-19 lockdown (31 March – 4 May 2020); T3, during the second COVID-19 lockdown (20 August – 23 September 2021); and T4, after the end of the COVID-19 lockdowns (1 February – 7 March 2022). Attendances were identified as mental health Medicare Benefits Schedule codes for face-to-face, televideo and telephone consultations. Patterns of attendances were evaluated using frequency analysis. Results There was a decline in mental health attendances compared to all attendances at the general practice from T1 (7.5%) to T2 (4.8%). During T4, mental health attendances returned to 7.1% of all consultations at the general practice. Face-to-face attendances decreased by 50% in T2 relative to T1, and this trend was maintained in T3 and T4, whereas the utilisation of telehealth approached that of face-to-face by T4. Discussion Post-pandemic policies that support the use of telehealth in general practice may help improve mental healthcare delivery and outcomes. THE COVID-19 PANDEMIC has created uncertainty around work, safety and financial security, thereby impacting the mental health of the Australian community. 1–6 By 30 March 2020, the Australian Government expanded Medicare-funded telehealth items to all Australians in response to the pandemic. 7 Although there were initial declines in healthcare activities across New South Wales (NSW), an analysis of the ‘40 weeks of the pandemic year’ (January 2020 – October 2020) reported an increase in the number of mental health Medicare Benefits Schedule (MBS) services provided, supporting the significant mental health burden as a consequence of COVID-19. 8,9 In March 2020, there was a 30% drop in face-to-face consultations and a rise in telehealth consultations across Australia. 10 For example, a time series study of attendances at a regional Victorian Aboriginal Community Controlled Health Organisation saw a 27% increase in all attendances from March to June 2020, suggesting that telehealth availability allowed greater accessibility to medical services. 11 Another study of changes due to telehealth use during the pandemic (to May 2020) found that women were generally higher users of health services and that this gender gap was greater for telehealth, 12 calling for an evaluation into factors contributing to this divide. There is also a literature gap pertaining to the ongoing trends in modes of healthcare delivery that extend past the initial ‘first wave’ of COVID-19 in Australia (March – September 2020). Given primary care’s frontline role in healthcare delivery and the rising mental health burden from COVID-19 restrictions, the aim of this study was to observe patterns in mental health attendances in a university-based community general practice in periods before, during and after the COVID-19 pandemic, specifically the distribution of face-to-face, telephone and televideo attendances. A secondary aim of the study was to explore the effects of age, ethnicity, birth sex and student status on presentation patterns. Given the temporary telehealth extension by the Australian Government in early 2022, the findings of this study will provide data for policy makers to consider the continuation and expansion of telehealth subsidisation. Methods Study design, population and settings Retrospective data were obtained from patients attending a university-based community mixed-billing general practice in Sydney