BC Medical Association

BC Medical Association

February 10, 2011 12:30 ET

BC Medical Association: Innovative BC Program Helps Family Doctors Provide Better Mental Health Care for Patients; Program Now Receives Canada-Wide Recognition

VANCOUVER, BRITISH COLUMBIA--(Marketwire - Feb. 10, 2011) - A groundbreaking training program in British Columbia is helping 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.

Called the adult mental health learning module, the innovative BC program is the subject of an article in the winter issue of the prestigious Canadian health journal, Healthcare Quarterly, published this week.

"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," says Louise Bradley, President and CEO of the Mental Health Commission of Canada.

Studies estimate that annually 10 per cent of the Canadian population will experience a mental health problem and 20 per cent of the population will have a mental illness in their lifetime. Often people see their family doctors first when experiencing a mental health problem, but many family physicians (FPs) feel poorly prepared to handle mental health issues. In fact, a survey of BC family doctors in 2008 rated mental health diagnosis, treatment and care planning as their highest priority need for further education, training and support.

In response to this need, the General Practice Services Committee (GPSC), 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, developed the adult mental health module. The GPSC built on an existing training manual created by a Victoria-based team lead by Dr. Rivian Weinerman. The Practice Support Program of the GPSC adapted the new package to be delivered in interactive learning sessions to family doctors in community practice in BC.

The learning module uses 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.

A year and a half after the mental health learning module was first introduced, 981 of the province's 3,300 community family doctors have enrolled. The goal is to have all FPs in the province who want this training to eventually be able to take the program.

A survey of FPs who have participated in the learning module shows overwhelming support for it, with 94 per cent saying the training had resulted in improved patient care and 98.5 per cent saying they had learned something new that they were now incorporating into their practice.

Dr. Bruce Hobson, a Powell River family doctor and an early attendee, raves about the program. "It has been the single biggest improvement in my practice in 28 years as a doctor," said Hobson, who estimates he uses the new skills every day with more than 50 per cent of his patients. "The skills are applicable not only to patients with mental health problems, but to a grieving patient, a patient who needs help with his or her weight problem, or the patient frustrated about their chronic health condition. In fact so much of what a family doctor does has a significant mental health component."

One such patient helped by Hobson is Emily Daniels*, 46, of Powell River, who has struggled with depression off and on since she was a teen. After Hobson completed the training module 18 months ago and began applying his new skills "everything changed" said Daniels, who had been his patient for more than 20 years. "He was always a good doctor but afterwards he seemed really enthusiastic about working with me and he had new tools and skills that were making a difference." Together the two began working on a number of cognitive behaviour techniques that Daniels says she now uses every day such as stopping negative thoughts in her head and silencing the inner critical voice. She was referred to the telephone coaching by peers part of the program, and now sees Hobson for counseling sessions and cognitive behavioural therapy (CBT) support. While she still has issues, her depression has greatly improved and her personal outlook is optimistic for the first time in years. "I feel confident that now, with Dr. Hobson's help, I am going to get completely better. I feel like he is now treating all of me, the physical and the mental."

One of the unexpected bonuses of the program, she feels, is that it 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 this program is fantastic and that every doctor in Canada should be exposed to it. It has made a huge difference in my life," says Daniels.

The learning module has a number of complex and complementary components, including diagnostic and assessment tools and enhanced treatment skills, including CBT that can be used in short visits in the doctor's office.

"The success of the adult mental health program shows how combining training and system supports with financial incentives can create real improvements in patient care and in physician job satisfaction," said Dr. William Cavers, co-chair of the GPSC.

The article, "Improving Mental Health Care by Primary Care Physicians in British Columbia" appears in the Healthcare Quality winter 2011 issue.

For more information:

The Healthcare Quarterly Article can be found here:

http://www.longwoods.com/content/22146

A number of individuals are available for interviews:

Dr. Rivian Weinerman, site psychiatrist at Vancouver Island Health Authority, who was the medical lead in developing the program;

Dr. William Cavers, co-chair of the General Practice Services Committee,

Dr. Bruce Hobson, a physician champion in Powell River who uses the program;

Louise Bradley, President and CEO of the Mental Health Commission of Canada.

*Emily Daniels is a pseudonym for a real patient of Dr. Hobson's. She is happy to speak to the media and talk about her struggles with depression and her successes on the program, if her confidentiality is respected and the pseudonym used.

BACKGROUNDER

Mental Health in Canada

  • Some 10 per cent of Canadians experience a mental illness in a given year.
  • Some 20 per cent will have a mental illness in their lifetime.
  • More than 80 per cent of patients first see their family doctor when a mental health issue arises. The need for improved integration of mental health care into primary care services has been a common theme in the last two decades in a number of mental health reports, including the landmark 2006 report Out of the Shadows at Last, the first national report on mental health in Canada conducted by the Canadian Senate Standing committee on social affairs, science and technology.

The Adult Mental Health Learning Module in BC

  • The module was developed by the Practice Support Program of the General Practice Services Committee, a joint doctor/provincial government committee established in 2002 to support full service family doctors. The mental health learning module is the fifth learning module developed by the Practice Support Program. For more information about the GPSC and its programs see www.gpscbc.ca.
  • In British Columbia, (pop. 4.5 million) about 640,000 individuals each year receive a mental health service from a GP, yet medical schools typically do not adequately prepare GPs to address this need.
  • A survey of BC family doctors found that mental health diagnosis, treatment and care planning were rated by them as their highest priority need for further education, training and support.
  • The adult mental health learning module was introduced in the summer of 2009 and by August 31, 2010, 981 GPs out of the province's 3,300 physicians had enrolled. By June 2011, some 1,100 BC family doctors are expected to have completed the training, or about one third of all doctors in the province.
  •  The aims of the adult mental health learning module are to:
    • increase physicians' skills and confidence in the diagnosis and treatment of mental health conditions, including improving prescribing skills as well as providing skills in evidence-based non-drug therapies such as cognitive behavioural therapy (CBT);

    • increase physicians' awareness of community mental health resources;

    • increase physicians' ability to develop care plans;

    • improve family physician collaboration with psychiatrists and mental health clinicians;

    • improve the patient experience, and promote the engagement of patients in the management of their mental health conditions; and

    • help Medical Office Assistants (MOAs) develop interpersonal skills for interacting with patients, skills in booking appointments for patients with mental health conditions, and skills for billing procedures for new fee codes related to mental health.
  • Doctors are paid for their participation in the program, with doctors receiving about $2900 for the learning sessions and action periods and reimbursement for their Medical Office Assistants at $20 an hour.
  • All programs are delivered locally so that physicians and their MOAs do not have to travel far or take too much time out of busy schedules.
  • The module consists of three training sessions interspersed with "action" periods where doctors and their MOAs go back to their offices and with support from a regional team, incorporate or tailor the changes into their daily practice.
  • Treatment strategies include the use of evidenced-based cognitive behavioural interpersonal skills in the form of one page handouts that are designed to be done with the patient in 10 minute sessions.
  • If the patient requires more intensive cognitive behavioural coaching (CBT), the GP can work with them in the use of Antidepressant Skills Workbook developed by the Canadian Centre for Applied Research in Mental Health and Addiction at Simon Fraser University.
  • Or, the doctor can refer the patient for more CBT help to a free, community-based program, called Bounce Back, delivered by the Canadian Mental Health Association. The GP provides the patient with a Bounce Back video and makes a referral for community telephone coaching. The CBT coaching is provided by a lay coach supervised by a psychologist.
  • A new mental health planning fee and management fee have also been established for doctors to bill for these services under the provincial medical services plan.
  • An initial evaluation to the end of March, 2010, found that GPs agreed or strong agreed on the following:
    • What they had learned had improved their practice (91.0%).

    • The training had resulted in improved patient care (94.0%).

    • They had learned something new that they were incorporating into their practice (98.5%).

    • Attendance at the learning module had increased their job satisfaction (78.5%).

    • The training had enhanced their skills to conduct a Diagnostic Assessment Interview (91.9%).

    • The training had enhanced their skills in treating mental health conditions (90.4%).

    • The training had enabled them to decrease their reliance on prescribing antidepressant medication (41.5%).

    • The care they could provide after having attended the learning module increased their patients' ability to return to work (61.9%).

Contact Information

  • For assistance in setting up interviews:
    Sharon Shore, BC Medical Association
    604-638-2832
    604-306-1866 (pager)
    sshore@bcma.bc.ca