Published on January 30th, 2018 | from CAMH
Increasing access to integrated mental health care support closer to home
By Dr. Allison Crawford, Director of the Northern Psychiatric Outreach Program at CAMH (NPOP-C) and Telepsychiatry, and co-Chair ECHO Ontario Mental Health
Eva Serhal, Director of Outreach, Telemental Health and ECHO Ontario Mental Health
Dr. David Rodie, Medical Head, Telepsychiatry, CAMH
#BellLetsTalk is a day when many Canadians speak up to raise awareness about mental health and to promote positive change in our communities. On this day, we are taking a moment to reflect on what is at the center of the #BellLetsTalk campaign – utilizing technology and communication to reduce stigma and increase access to mental health services for all Canadians.
Geography poses a significant barrier to care for many Ontarians, which we can overcome through the use of technology. More people across Canada have access to high speed connections, making innovations such as telepsychiatry a possibility. This in turn allows us to improve access for people in more remote or rural parts of the country by connecting service users with service providers at a distance. Improving equitable access to mental healthcare guides our mandate in the telepsychiatry program at CAMH. Our program works with over 225 communities across Ontario, reaching individuals in underserved communities where access to mental healthcare is limited.
The program is also supported in part by the Medical Psychiatry Alliance, a unique Canadian health care partnership that aims to transform care for individuals with co-occurring mental and physical illness.
What is Telemental Health?
Telepsychiatry is a model of care that provides access to real-time psychiatric assessments and care using a secure videoconferencing platform. Our program has started to move towards more of a Telemental Health model, in keeping with our emphasis on collaborative and interprofessional care.
In the CAMH Telemental Health program, individuals across Ontario can access psychiatric care, via secure videoconference, from a psychiatrist at CAMH. In the original model of care through our program, clients are referred by their provider to be seen by the first available psychiatrist for a one-time consultation. However, we found that this model didn’t do enough to break down the ‘silos’ patients often experience when engaging with multiple providers in our health care system. Since the launch of the Medical Psychiatry Alliance in 2014, CAMH began to create and implement a new, collaborative care model of telemental health.
The new model is supporting primary care providers to better meet the mental health needs of their clients.
To that end, CAMH collaborated with the North East and North West Local Health Integration Networks as well as Family Health Teams throughout Northern Ontario to create ongoing partnerships, virtually embedding a dedicated CAMH psychiatrist within a Family Health Team via video conferencing.
This collaborative model was designed to address identified needs by increasing access to psychiatric services within the primary care setting and increasing continuity of care for patients and providers. Community-based Family Health Teams are partnered with a psychiatrist for regular and ongoing access to both direct care (seeing the client directly) and indirect care (connecting with the client’s primary care team), thereby creating virtual multi-disciplinary teams across the province.
To date, we have partnered with 12 Family Health Teams throughout Ontario and have plans to expand to include more teams over 2018. Feedback from these teams has been resoundingly positive, with primary care providers noting many benefits, including:
- Opportunities for skill building;
- Knowledge gains;
- Improved access to care, including shortened wait times.
As we reach out to new teams, we continue to hear from providers about their interest in the program and the significant needs that exist in their respective communities. Increased collaboration leads to increased access to care for the clients in those communities, and also provides support and enhances capacity for the health and allied health professionals.
Using Research to Improve Care
Research supports the use of collaborative care models to improve client care by bringing together the expertise of varying interdisciplinary team members. Through the support of the Medical Psychiatry Alliance, we have initiated a research project to directly examine client mental health outcomes related to the collaborative care model, and to hear from clients about their unique experiences. The findings of this research will contribute to the evidence-base around best practice in telemental health, and will help guide future innovations in the delivery of care, and help inform decisions within our Telemental Health program.
As telemental health services continue to expand in both the public and private sectors, we are hopeful that geography will become less of a barrier to care, allowing individuals to more readily access services close to their communities. We are looking forward to continued growth of this model, as well as ongoing integration with our other outreach programs and services, including the Northern Psychiatric Outreach Program, which provides fly-in and drive-in mental health services to underserved northern and rural communities, as well as ECHO Ontario Mental Health at CAMH and the University of Toronto, which supports primary care providers to build capacity in the assessment and treatment of mental health issues through weekly virtual clinics.
Telemental health is growing rapidly and we are excited to see what this next year will bring in this emerging and promising area, both within our program as well as in the broader mental health community.
With contributions from Anne Kirvan, Clinical Coordinator, Telemental Health and ECHO Ontario Mental Health.
To watch a video highlighting some telepsychiatry dos-and-don’ts see: https://www.youtube.com/watch?v=K4unpA1Se5I