Family physicians regularly provide mental health care for their patients. In fact, evidence shows 35 per cent of individuals suffering from mental health disorders are treated by their family doctors in a primary care setting. Yet many family physicians report encountering difficulty in accessing services and support to provide care for their mental health patients.
Consequently, when the family physicians with privileges at Trillium Health Centre indicated they would appreciate an innovative, integrated approach to better care for their mental health patients, Trillium welcomed the opportunity to pioneer a shared mental health care program. Trillium had previously developed a shared mental health care model with LAMP Community Health Centre, located in Etobicoke, which had proven quite successful. Following discussions with other community organizations such as St. Joseph’s Health Centre in Toronto, the HSO Mental Health Program in Hamilton, and the Ontario College of Family Physicians, Trillium developed a model to increase family physicians’ knowledge and comfort in treating mental health patients, provide patients with quick access to psychiatric consultations, and improve mental health providers’ understanding of what is necessary to support family physicians. Family physicians will also benefit from rapid access to consultation services and support from a mental health team.
This pilot, which began in October 2002 and will continue until June 2003, includes several family physicians and a clinical team and is supported by Trillium’s Mental Health System and the Primary Care and Community Health Initiative. In the shared mental health care pilot, family physicians are able to refer patients to a team of nurses, social workers, and a psychiatrist for rapid consultation. Recommendations made by the team are provided to the family physician and the mental health team and the physician work together to link patients to appropriate treatment. While patients remain in the care of their family physician, the mental health team is available to advise and assist with implementation of the recommendations. Physicians will meet once a month with the mental health team to discuss cases and learn about advances in mental health such as new medications.
“This project will provide rapid access to consultation for our patients and will provide backup for us to continue to manage those patients,” says Dr. Cheryl Hewitt, a family physician participating in the pilot. “It is a great advantage to have that support as mental health care providers and we look forward to working with the team.” Dr. Suzanne Legault, Trillium’s Chief of Psychiatry and the participating psychiatrist on the team, says offering this service will enhance both primary care and mental health services through better communication and learning opportunities.
Positive evaluation results based on patient and provider satisfaction, patient outcomes, and physician knowledge and comfort in handling mental health problems will result in an effort to expand to all family physicians at Trillium in the future.
The environment to foster shared care at Trillium began in 2001, when the Health Centre recognized the need to strengthen their focus on supporting and promoting improvements in primary and community care. A planning committee was struck to review supports for primary care and the result was the creation of Trillium’s Primary Care and Community Health Initiative. This initiative consists of 26 action-oriented strategies to support the role of primary care physicians, strengthen information and communications, and improve how primary care and community care are provided. Trillium’s Primary Care team is currently exploring new methods of collaboration between primary care physicians and specialists in several clinical areas including cardiology, adult diabetes, and geriatrics.