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Canadian Mental Health Shared Care: A Beginning

Posted By Gary Mazowita, Thursday, March 10, 2011
Updated: Friday, June 10, 2011

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 patients.

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:

  • Tools 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 "collaborative team”.
  • Building 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).
  • A "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.
  • Payments 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 American colleagues.

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.

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