By Donna Harris
For people living with mood and anxiety disorders, timely access to the right clinical supports can make all the difference in the world to quality of life. It’s that thinking that prompted William Osler Health System (Osler) to launch a novel approach to service delivery that is dramatically improving wait times for services – all without any changes to staffing, space or resources.
“When people are on waiting lists, their condition can continue to deteriorate,” says Carol McCafferty, Clinical Services Manager, William Osler Health System. “Our Stepped Care Model for Mood and Anxiety Disorders provides people with increased options for care that offer the best chance of positive outcomes.”
Osler has one of the largest mental health and addiction programs in the province. Of the 75,000+ people it sees each year, close to 70 per cent are seeking help for mood and anxiety disorders. To help ensure easier access to services, Osler took a proven national program used in the United Kingdom, and successfully scaled it to their community to help address the more than 1,400 referrals it receives each month for services.
Since introducing the Stepped Care Model in January 2019, Osler has almost doubled access to its outpatient mental health programs and intervention services, and significantly reduced wait times to see a psychiatrist or psychotherapist.
“Our goal was to increase access to services, reduce wait times, decrease visits to the emergency department, and increase patient and primary care satisfaction,” says Faiza Khalid-Khan, Osler’s Director of Mental Health and Addictions. “So far, the Stepped Care approach is living up to its reputation on all fronts, reducing the time to see a psychiatrist from 12 months to four, and access to group services from six months to 1-4 weeks.”
Matching patients to services based on level of need
The model’s four-step approach matches patient level of need to level of service, reserving the most intense, resource-rich services for patients with the most complex needs. Prior to implementing the model, mental health services tended to focus on individual therapy and longer-term support, leading to long waits, particularly for psychiatry services.
By reconfiguring existing resources and staffing, Osler was able to increase the number of low intensity services available to patients and expand the number of therapeutic groups from 21 to 53. A new centralized intake process ensures patients are referred to the most appropriate service to meet their needs.
“We don’t want to burden patients with more services than they need,” says Carol. “Through Stepped Care, patients can enter the model at the level of service that will best meet their needs. For some, the services in one level might be all they need prior to being discharged from the program, while others may need to move through two or more levels, up or down, depending on how well they are doing.”
Step 1 is low intensity, offering self-management skills and an introduction to relaxation strategies. Step 2 focuses on cognitive behaviour therapy, teaching patients techniques for dealing with symptoms of anxiety and depression. Step 3 offers more intensive therapy for mood and anxiety disorders, while Step 4 delivers more 1:1 counselling.
“The model’s flexibility means that treatments are more tailored to individual needs,” says Carol. “If a patient isn’t comfortable doing group therapy, they will initially receive 1:1 therapy with the ultimate goal of transitioning to a group.”
Adopting a consultative approach to psychiatric care
Osler has also moved psychiatry referrals to a consultation/collaboration model with primary care providers. A psychiatrist may see a patient for one or more sessions, then refer the patient to the Stepped Care Model, with follow-up care upon discharge going back to the referring primary care physician rather than to the psychiatrist.
“Historically, primary care providers would refer a patient to a psychiatrist and that patient might be with that psychiatrist for the rest of their life,” notes Faiza. “But advances in medications and more sophisticated outpatient mental health services means primary care providers are better equipped to monitor the ongoing needs of their patients, leaving psychiatrists with more capacity to focus on those people with the highest intensity needs.”
Donna Harris works in communications at William Osler Health Sytem.