Pilot project reporting improved patient care, changes in traditional practice
A version of this commentary appeared in the Toronto Star
People often see their family doctors first when experiencing a mental health problem, but many family physicians feel poorly prepared to handle mental health issues. Doctors receive very little training in mental health issues during medical school. Family physicians in Saskatchewan have identified education on mental health problems and resources as a key area for improvement in their provision of mental health care. Family doctors in British Columbia have also rated mental health diagnosis, treatment and care planning as their highest priority need for further education, training and support.
Now, a groundbreaking training program is helping BC family physicians provide better care to their patients with mental health conditions — and is receiving positive reviews from the doctors who have used it, the patients they help, and mental health organizations across Canada.
In BC, a group called the General Practice Services Committee (GPSC), turned to BC mental health experts to develop and adapt a training program for busy family doctors. The GPSC is a joint initiative of the BC Ministry of Health Services and the BC Medical Association with a mandate to support and sustain full service family practice. The adult mental health module consists of three, half-day interactive learning sessions delivered to family doctors in community practice around BC. The learning sessions are interspersed with action periods during which the doctors make the changes required in their practices to try out what they have learned with their patients.
The learning module uses family practice (FP) “champions” to teach their colleagues the materials that cover screening tools, diagnostic assessment, treatment options and long-term care planning. An important aspect to success is that medical office assistants (MOAs) are also included in the training program to learn about scheduling and enhancing interpersonal skills, in regard to mental illness.
The learning module has a number of complex and complementary components, including training in cognitive behavioural therapy skills that can be used with patients in short visits in the doctor’s office. As well doctors learn about mental health resources in their community and can refer the patient for telephone coaching and other supportive programs.
First introduced in the summer of 2009, by March 2011 more than 1200 of the province’s 3,300 family doctors had enrolled. The goal is to have all family physicians in the province who want this training to take the program.
A survey of GPs who have participated in the learning module shows overwhelming support for it, with more than 90 per cent saying the training had resulted in improved patient care and 97 per cent saying they had learned something new that they were now incorporating into their practice. The vast majority (an average of 87 per cent) said it had enhanced both their skills and their confidence in diagnosing and treating mental health conditions. GPs were asked to report on progress some 3 to 6 months after the end of training. More than 80 per cent reported they had used various mental health diagnosis and treatment tools and 94 per cent reporting that their care has had a high impact on their patients. Some three to six months after training doctors noted that, for 79% of patients, their ability to return to work was better, or much better. More over, the majority of physicians job satisfaction had improved. Waiting lists now exist for doctors to take the training, evidence that family doctors want to improve their skills and better help the large number of patients with mental health issues in their care.
Dr. Bruce Hobson, a Powell River family doctor and an early attendee, says “it has been the single biggest improvement in my practice in 28 years as a doctor.” Hobson estimates he now uses the new skills every day with more than 50 per cent of his patients. “So much of what a family doctor does has a significant mental health component,” he says.
One patient helped by Hobson is a 46-year-old Powell River mother, who has struggled with depression for years. After Hobson took the module, she noticed that he became enthusiastic about working with her. With him she learned cognitive behaviour techniques that she now uses every day such as stopping negative thoughts in her head and silencing the inner critical voice. Her depression has greatly improved and her personal outlook is optimistic for the first time in years. “I feel like he is now treating all of me, the physical and the mental.” She also feels that CBT has helped her lose 100 pounds. She no longer deals with emotions by over eating and her blood pressure has returned to normal. “I think every doctor in Canada should be exposed to it. It has made a huge difference in my life,” she says.
The cost-effective program is easily transferable to other parts of Canada and could help reduce stigma, improve access to timely and effective care, and improve patient health. In fact, Louise Bradley, President and CEO of the Mental Health Commission of Canada has noted about the BC program: “This innovative approach to reach and educate such an important group of physicians has the potential to improve the quality of help individuals with mental health problems receive from their family doctors all across Canada.”
Dr. Rivian Weinerman is the Regional Head, Division of Collaborative Care Psychiatry, Vancouver Island Health Authority, and the lead developer of the GPSC Mental Health Training Module.
Marcus J. Hollander, PhD, is a national health services and policy researcher and an expert Advisor for EvidenceNetwork.ca, a comprehensive and non-partisan online resource designed to help journalists covering health policy issues in Canada. His firm is conducting a comprehensive evaluation of training modules for the GPSC.
This work is licensed under a Creative Commons Attribution 4.0 International License.