The Role of the Family Physician in Collaborative Mental Health Care
I really appreciate the model of collaborative care but it seems that a lot of my colleagues don’t fully understand how it works or why it’s so helpful. In this blog I’ll talk about how the family physician can benefit from this model when it comes to their patient’s mental health care.
The typical GP in Ontario is extremely busy. Many are over-extended, with increasing levels of paperwork and less time than ever to spend with their patients. But what do they do if they have patients with challenging mental health problems?
Even under the best of circumstances, it can be very daunting to diagnose and treat a person with mental health issues. Many of these individuals have atypical symptoms that don’t show up in the medical books; often, a person is less than forthcoming when describing their problems.
It can take an awful lot of time and effort to fully understand what these patients are going through – time that’s in short supply for the average family physician.
The family doc is doing their best to assess and treat all of their patients but when it comes to mental health it’s rarely a straight-forward matter. Many patients present with subtle signs; others have symptoms that resemble other conditions. The complexity of mental health problems are not the fault of the family physician. They simply don’t have an hour or more to devote to each patient who comes in with a new and serious mental health issue. Unfortunately, many of these patients will require a lengthy interview in order for their physician to make sense of the complex issue they’re dealing with and understand how to treat it.
Without the proper diagnosis, many of these patients will soon return to the doctor complaining that they’re not feeling better. Unfortunately, these patients will continue to return and complain about their symptoms until they get the relief that they’re hoping for. They’re taking up a lot of the GP’s time, and nobody is the happier.
Since psychotherapy always matters, psychotherapy providers should be integrated into the care of the family doctor’s patients. This is where collaborative care comes in. Therapists can provide case-management and psychological treatments. The psychiatric consultant is uniquely positioned to assist in assessing the patient’s condition and in recommending a course of treatment best matched to the patient’s needs.
The psychiatric consultant has optimal time to ask all the questions required in order to come to a working diagnosis. Subtle conditions or those that masquerade for another can be seen for what they are, and the patient will have the opportunity to quickly find relief. Working hand-in-hand (or in our case, laptop-to-laptop) with a qualified therapist makes the assessment process more effective and efficient.
Instead of continually returning to the doctor seeking answers, these patients are now armed with a diagnosis, recommendations for treatment and an ongoing relationship with a therapist. The family physician can rest assured that their patient is on the road to recovery.
Sometimes, the family physician wants the consultant to write the prescriptions for the patient, but this belies the model of collaborative care. As a one-time consultant, I often don’t follow the patient in an on-going manner.
It’s preferable that the family doc orders the medication as they’re aware of all the other medications the patient is on and they’re fully apprised of the person’s medical history. Also, they can see the person at short notice if there are any adverse effects of the medications. This offers a better standard of care to the patient.
Sometimes, the family doctor is reluctant to write a prescription for a medication that they’re not familiar with. In my mind, this is an excellent opportunity for the doctor to do some research and acquaint themselves with this medication. They’ve now discovered a medication that might be also useful for other patients of theirs who suffer from a similar condition.
Sometimes the family physician takes issue with the collaborative model because their patient must be in the care of a therapist in order to receive a consultation from Psychotherapy Matters Virtual Clinic. They feel uncomfortable suggesting that the patient pay out of pocket for mental health care.
In the best of all possible worlds, all psychotherapy would be covered by a government health plan, but such is not the case today. There is a shortage of publicly-funded physicians who can diagnose and treat complex mental health issues. Many patients wait for onwards of a year to see a psychiatrist and these individuals will suffer during the entire waiting period.
On the other hand, there are a large number of qualified therapists in Ontario who are able to treat patients with a multitude of mental health conditions. People are willing to pay physiotherapists, optometrists and dentists; it‘s unfortunate that they’re reluctant to pay for mental health care.
Psychotherapy Matters supports the GP by offering diagnostic and treatment recommendations, and the psychotherapist supports the GP by providing ongoing mental health care. This collaborative model is a win-win.
The family doctor is assisted on two fronts: by the consulting physician and by the psychotherapist. Their time is freed up and they can participate in high-quality care of the individual with a wide variety of mental health needs.
The family physician can make use of this collaborative care model in a number of ways. If the patient is already seeing a psychotherapist, the GP can request a consultation with Psychotherapy Matters Virtual Clinic directly. Or, the GP can make the referral if approached by the patient or by the psychotherapist who is requesting greater insight on the patient.
Once the referral is done, a report will be sent to the physician and to the therapist, so that everyone is on the same page in terms of the diagnosis and treatment options. The patient will then see the family doctor, who will review the report and provide the patient with the recommended prescription(s), based on their medical judgment.
In this model of collaborative care, everyone is working together for the benefit of the patient. It’s not a perfect system, in that all parts aren’t covered by the health plan, but it gets the patient in to see a psychiatrist in a timely manner and it saves the family doctor a lot of time and stress.
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The views expressed in these blogs are the author’s own and not necessarily reflective of those of Psychotherapy Matters. Information provided here and anywhere else on PsychotherapyMatters.com is for learning purposes only and should not be used to guide treatment of clients/patients. Copyright © 2018 PsychotherapyMatters.com
Marcia Sirota
Dr. Marcia Sirota, MD, FRCPC, is a psychiatrist, coach, author, speaker, and prolific Huffpost contributor. She completed her residency at Maimonides Medical Centre and has over 25 years of experience in health and wellness focusing on long-term results. Dr. Sirota enables people to overcome adversity, obstacles, mental blocks, to improve effectiveness, performance, and leadership. Her achievements include 5 books and hundreds of published articles on personal and organizational development. In 2016, Dr. Sirota was named one of the Top 50 most influential bloggers and communicators in Canada.