Improved mental health care with FPs and patients as partners

Issue: BCMJ, Vol. 51, No. 9, November 2009, page(s) 387 GPSC
Greg Dines

The newest Practice Support Program (PSP) module from the General Practice Services Committee (GPSC) targets the needs of general practitioners and their medical office assistants on the front line of mental health care in BC. Family physicians screen, diagnose, and treat about 85% of the province’s mental health patients.

Launched in late September, the mental health module offers family physicians specialized skills training and tools to enhance their patient relationships and support improved mental health care for patients across the province.
From personal experience, Vanderhoof elementary school teacher Ms Jo Johns is convinced the new module will make a big difference for patients with mental illness.

Ms Johns, who experienced serious depression earlier in her life, moved to the northern community with her two daughters in 2004. Not long after the move her mental health began to decline, and within 2 years she relapsed into depression. It took a further year-and-a-half before she was diagnosed with bipolar disorder. According to Ms Johns, her family physician was ill-equipped to recognize her mental health problems until it was too late. 

“He did the best he could, but he didn’t have the tools or special skills to understand the full nature of my illness,” says Ms Johns. “We also hadn’t had time to build the relationship that might have helped that understanding.” 

Ms Johns believes the training and assessment tools available from the new mental health module would have helped her physician identify her mental illness and ensure she received the specialized care she needed more quickly. 

Ms Johns has good reason for this belief—she was involved in the development of the module and provided a highly valued patient perspective for physicians in the initial training sessions. During these sessions Ms Johns was impressed by the attention that the physicians gave to her experience and learned much about the importance of the patient-physician relationship.

“It also made me realize how im­portant asking the right questions is to that relationship between doctor and patient,” says Ms Johns.

Among the various resources provided by the mental health module is a diagnostic assessment interview tool that physicians piloting the module found very useful. The module also includes a patient self-management workbook, a tool for organizing pa­tient issues, and a cognitive-behavioral skills tool.

Some of the physicians involved in early testing of the module and its resources shared their experiences in a listserv (a type of group e-mail) set up to support participants. In one posting a physician wrote, “It is amazing what you learn about patients by asking these questions and by going over the work they bring in.” 

In another note on the listserv, the same physician mentions a revealing comment she received from one of her patients. Responding to her use of the new assessment tool, the patient said she “didn’t seem like the same doctor” and that in the past the patient had felt “like a sausage in a factory.” This came as a shock to the physician, who says she didn’t think she was “that kind” of doctor.

Most physicians found the module helped instill confidence, empowered them, and provided an enormous shift in how they felt about working with patients with mental illnesses. This result and the tools provided allowed many physicians to:

• Uncover a significant amount of personal trauma about which pa­tients had never told their physician or anyone else previously.
• Uncover patients who were living with treatable conditions.
• Work collaboratively on the tools on their computer with the patient by their side.
• Incorporate techniques from psychiatry to help patients manage their condition after a diagnosis is made.

On the practice management side, many physicians found the module one of the most practical initiatives they had ever incorporated into their practice, primarily because of the tools and the structure that help them do their job better and with more time for the patient.

It is expected that up to 700 GPs will participate in the mental health module over the next year. The module supports an incentive payment introduced last year to compensate family physicians for their efforts in providing mental health care for patients. 

The incentive payment and the mental health module are programs of the GPSC, a joint initiative of the BCMA and the Ministry of Health Services. More information is available from Ms Adrianne Darling at the BCMA, 604 638-2903 or adarling@bcma.bc.ca.

—Greg Dines
Senior Program Advisor, BCMA

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