The upcoming Halifax Collaborative Mental Health Conference both
exemplifies and showcases the kinds of changes that are currently taking
place in the Canadian healthcare system related to mental health.
After a decade of "talking about” the changes necessary to ensure
ongoing sustainability in the face of an ageing population and evermore
expensive and sophisticated tests and treatments, things are finally
happening in visible fashion, in virtually all areas of the country.
A cornerstone of change in all locales is "collaboration”. Such
collaboration is not narrow, but rather attempts to engage a broad swath
of society at large: family doctors, specialists, other healthcare
providers such as nurses, nurse practitioners, psychologists,
pharmacists, social workers, and perhaps most importantly, families and
In many ways, mental healthcare has been the "crucible” of
change…..perhaps largely because the need was so pressing, and the
existing delivery models so stretched, and even dysfunctional.
Fascinating to me has been the apparent willingness of the mental
health consumer population to accept, and even endorse, certain aspects
of the "medical model of care”. Historically, the term "medical model”
has conjured up values of paternalism, dogma, and elitism. Now, it
seems, there is exciting openness to some of the "good” things possible
from certain aspects of this model, particularly in the domain of
"chronic disease management”. Elements include active patient
engagement, self-management, goal-directed choice, recall systems,
planned proactive management, attention to routine primary care, and a
range of collaboratively-oriented providers.
It is fair to say that there is now more interest in mental health,
and in collaborative mental health models of care specifically, than has
ever been the case in Canada.
If this "cultural change” continues (and it surely will, if we expect
to enjoy the benefits of our publicly funded healthcare system) then
the next decade will likely witness a transformative change in mental
health service delivery, and in stigma reduction as well.
In my province alone (British Columbia), some noteworthy developments have been:
and supported office change for family doctors and their Medical Office
Assistants (MOA). These have been extremely well received, and are
available under "Practice Support Program’ at www.gpscbc.ca.
One particularly exciting element of the "Adult Mental Health Module”
is the provision for MOAs to take the "Mental Health First Aid Course”.
This course helps to educate and sensitize MOAs with respect to
prioritizing appointment-making, waiting room environment, signage,
conflict resolution, etc. This truly brings MOAs into the
on the above, more and more shared care models between family doctors
and psychiatrists, and more recently psychologists, pharmacists, and
nurses, are being discussed, or being planned, or exist. There is an
expectation that this direction will continue, and will expand.
- The "Bounceback” program of peer cousellors, who connect to patients by phone, has been well-received, and is expanding.(www.cmha.bc.ca/bounceback).
"Child and Adolescent Mental Health Module” is nearly complete, and
will complement the adult module, and likewise encourage collaboration.
It should eventually be available on the gpsc website.
to family doctors and psychiatrists are increasingly being aligned to
support collaboration. We believe this will not only ensure
sustainability of our publicly funded system, but improve the patient
journey, and provider work-life. Still largely outside the
publicly-funded umbrella are psychologists and others, although creative
solutions are beginning to appear.
Similar initiatives are ongoing in other parts of Canada, and venues
such as the Halifax Conference allow us to learn from each other, and
both drive and spread change. On behalf of the Shared Care Mental
Health Committee (College of Family Physicians of Canada, and Canadian
Psychiatric Association) we are happy to engage in dialogue with our
To quote an old American proverb: If you don’t believe in cooperation, watch what happens to a wagon when one wheel comes off.
Together, we are stronger.